Unbiased Analysis of Today's Healthcare Issues
How much care should doctors give to terminally ill patients in the ICU? This is a question which can be answered on many levels (e.g., societal, individual, technical). One physician gives his thoughts in an n+1 magazine article titled “First, do no harm.” While advanced medical technology has lead to greater longevity and healthier lives,…
Many studies have attempted to determine how the manner in which physicians are compensated by health insurance companies affects the quantity of medical care provided. Today I will summarize some seminal studies in this field. Epstein, Begg and McNeil (NEJM 1986) In this study, the authors examine whether or not there is a difference in…
Paul Levy, the president and CEO of Beth Israel Deaconess Medical Center in Boston made about $1 million dollars in 2005. Of this, $650,000 was base salary, $195,000 was made up of incentive bonus, and the balance was composed of compensation for health insurance, life insurance, and retirement. How do I know these figures? Paul…
A recent article in the Journal of Health Economics found that increasing Medicare reimbursement may have no meaningful effect on hospital use or patient outcomes. “There is widespread concern about the quality of health care in the US, and the effect of provider payments on the quality of care is an important and unsettled issue…
An interesting article (“Sudden Death…“) at the Covert Rationing blog addresses the poor care given to cardiac patients in hospitals. Dr. Rich states that: “…hospitalized patients who have cardiac arrest (sudden loss of cardiac function due to the onset of a heart arrhythmia known as ventricular fibrillation) are often not receiving defibrillation (an electrical shock…
There has been a recent trend for more and more surgeries to take place in ambulatory surgery centers (ASCs). In fact according to the Medicare Payment Advisory Commission, in 2004 up to 70% of surgeries took place in these ASCs. Do ASCs offer better quality surgical procedures than Hospital Outpatient Departments (HOPD)? ASCs may be…
A New Yorker article (“The Checklist“) recounts Peter Pronovost’s efforts to improve the delivery of medical care. One of his simplest ideas was to invent a 5 step checklist to reduce line infections: Doctors are supposed to (1) wash their hands with soap, (2) clean the patientâs skin with chlorhexidine antiseptic, (3) put sterile drapes…
Revascularization (bypass surgery or angioplasty) have been frequently used procedures to treat patients who have experienced a myocardial infarction (MI). These procedure are expensive, but are supposed to enhance longevity. Do they? This is the question analyzed by David Cutler in his NBER working paper titled “The Lifetime Benefits of Medical Technology.” The problem with…
Many papers have attempted to calculate hospital efficiency before and after a policy change. Most research, however, does not take into account quality levels when analyzing these changes in efficiency. For instance, a doctor may increase the number of patients per hour that they visit by 50%, but if this is accomplished simply by lowering…
Should hospitals with long waiting times have higher or lower budget transfers? Offering hospitals who have low wait times more money will increase a hospital’s incentives to decrease wait times. On the other hand, thus policy may hurt the busier hospitals and may not alleviate the wait times of those who are waiting the longest.…