Archive for August 19th, 2006

An article in the New York Times presents a microcosm to a phenomenon that occurs throughout medicine.  In Public Health school we call this “small area variation,” and it drives insurers completely nuts.

When it comes to treating blocked arteries, there are no definitive studies showing which approach most benefits patients in the long term. And some local insurers agree that the Elyria hospital provides high-quality care.

But there is little doubt that hundreds of Elyria patients each year are getting angioplasties that they would not be getting if they lived elsewhere in Ohio — or in any other part of the country for that matter — at a cost of millions of dollars a year to Medicare, the federal insurance program for the elderly. Elsewhere in the state, some of the sickest of these patients might have received bypass surgery, while many others might have simply been treated with drugs. Or, for those whose conditions were not diagnosed or were not deemed serious enough, there might have been no treatment at all. .

Experts know that changing the financial incentives can change the way medicine is practiced.

A major problem, as cited above, is that often times medical technology and approaches change so fast that it is very difficult to have definitive studies.  At the same time, many doctors are not comfortable with the fiscally conservative approach which demands that the cheapest method be used unless a more expensive option is proven to be more effective.  The truth is that many other industry have practices that don’t demand clear undisputed evidence, and medical practice will often not advance without it.

Still, small-area variation clearly is evidence that a problem exists.  Both groups of doctors can’t be right, and extreme variation like this only make it obvious the degree to which we simply don’t know.

complete story below


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