post by Bill Gardner
Paul had a great post last week that discussed the overuse of expensive technology in health care, in situations where less intensive or cheaper care would be as effective.
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."
I want to point out that the situation is sometimes worse -- or perhaps just more tragic -- than he described.
I have had the privilege of working for several hospitals, including some that were non-profit in spirit as well as law, that is, with a strong commitment to the health of the populations they served. At one, I got to know the Chief Financial Officer quite well, because I regularly came to him with proposals for improving the quality of pediatric mental health care. After children get through early childhood, mental health problems are the most important source of pediatric morbidity. I needed his commitment to small capital investments for clinical process innovations. Here is our dialogue, digested across several conversations and with the diplomacy edited out.
CFO: "I am already losing money on community mental health care." [A sad truth]
Me: "So what? We are trying to prevent adolescent suicides." [My cause of the month...]
CFO: "You know that MRI machine you bothered me about last week? The imaging studies that, in your non-medical opinion, are over-prescribed? What do you imagine is paying for the community mental health care?"
The CFO was fully committed to children's well-being. However, the incentives that he faced were wrongly calibrated. The excessive profit he made on imaging was used to subsidize mental health, where he was under-compensated. Because he manages a budget, however, all his choices are interdependent. Correcting the overuse of expensive technology is, sometimes, harder than it looks.