Some stuff I know about health care, I think, via
David Dranove :
- Most reliable indicator of surgeon skill: number of surgeries performed. But nobody is quite sure why: could be because he gets lots of practice, could be because the good ones get a lot of business.
- Most reliable source of information about the quality of specialists—your primary care doctor, if (big if) your primary care doctor will tell the truth. But whom does s/he want to please more—the network of specialists, or you?
- A generation ago, a lot of uninsured got medical care via compulsory cross-subsidies. Translated: providers who got money to build hospitals under the Hill-Burton Act were required to provide services to the unserved. So paying patients unknowingly paid for the non-paying.
- Using emergency rooms for non-emergency care is not as goofy an idea as it seems. The big item for an emergency room is having the team ready for, well, for emergencies. The marginal cost of using their extra time to treat non-emergencies is near zero. If the patient is willing to wait, might as well let the docs use their extra time that way.
- Our model of medical care is still Dr. Marcus Welby, MD, of the TV show (link). Interesting thing is, though, that the Dr. Welbys of the world weren't all that good at doctoring. They got away with a lot of mistakes because people trusted them. Incidentally: somebody must have explored the proposition that the ultimate model of modern manhood was Robert Young—star of both Marcus Welby and Father Knows Best—and that Young suffered from alcoholism and depression, culminating in a suicide attempt (link).
2 comments:
>>Using emergency rooms for non-emergency care is not as goofy an idea as it seems. The big item for an emergency room is having the team ready for, well, for emergencies. The marginal cost of using their extra time to treat non-emergencies is near zero.<<
You forgot to mention that the marginal cost to impoverished emergency room consumers is their lives.
You can't walk into an emergency room and say, "Hey, doc, nothing's really bothering me but I'd like a Thallium stress test, a full blood profile, and a colorectal exam just to make sure." They might, at some exceptional hospital, actually see you. But in big cities you'd have to sit in the waiting room for 14 years.
You need a complaint to get seen. You have to be having a heart attack, bleeding profusely from the rectum, or dying of a blood clot to the brain before they'll look at you. And by then, a perfectly fine diagnosis might be just a tad too late to do any good.
Of course, there's always the Conservative philosophy that if you're too poor to pay a doctor, you deserve to die.
Yours Crankily,
The New York Crank
"But in big cities you'd have to sit in the waiting room for 14 years." Yes, this can happen here and we don't have "Conservative philosophy that if you're too poor to pay a doctor, you deserve to die." Because sopmebody has to pay the doctor, they are not slaves. I am selling optional health insurance with life insurance in Canada and in recent months we have seen some attempts here to spread private insurance to goverment covered areas, because if you can't afford treatment, it's bad, but when you can afford it and still don't have it, it's even worse I think...
Best wishes!
Lorne
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