post by Paul Kelleher
Friday saw another report that health care professionals fail to wash their hands at alarming rates and that their clothing is more likely than not to be colonized with potentially pathogenic bacteria. This is obviously shameful.
Relatedly, over the weekend I read a great working paper by Katherine Baicker and Amitabh Chandra entitled "Aspirin, Angioplasty, and Proton Beam Therapy: The Economics of Smarter Health Care Spending." Baicker and Chandra refer to a 2009 study by Skinner and Staiger which found that providers "fail to do very simple things like handwashing, prescribing prophylactic antibiotics before surgery, or using beta-blockers for heartattack patients." Just like failing to wash one's hands, the failure to prescribe beta-blockers for heart attack patients is just unconscionable. Beta blockers are super cheap but can reduce mortality associated with heart attacks by 25%. Still, Garber and Skinner report that the use of beta blockers "varied from just 5 percent of patients in McAllen, Texas, to over 80 percent in Rochester, New York, during the mid-1990s."
These failures have profound consequences for both lives and cost. Here again is Baicker and Chandra:
[I]mprovements in health are often generated because of relatively low-tech technological progress. One recent study provides direct evidence of this theory to explain the decline in mortality from coronary disease during 1980-2000 into specific causal factors (Ford et al. 2007). Over 40 percent of decline can be attributed to changes in smoking, physical activity, blood pressure, and cholesterol (and offsets from rising obesity and diabetes). 35 percent of the decline is attributed to inexpensive but highly effective treatments: aspirin, beta blockers, blood-thinning drugs, anti-hypertensives, diuretics, and pharmaceuticals such as ACE inhibitors, statins, and thrombolytics (“clot-busters”)...Expensive treatments, such as angioplasty (stents), bypass surgery, and the diffusion of cardiac rehabilitation and cardio-pulmonary resuscitation (such as automated defibrillators) explain 11 percent of the improvement, but almost all of the spending increase.
As Aaron Carrolls says, "this is pretty low hanging fruit. We should be able to fix these issues easily." Indeed, we must.