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Can Effective 金博宝188betHealth Care Reform Occur In This Geographically Varied Country?

There is a romantic view of America as a homogeneous nation – a nation that is flat.But the real America has high peaks of affluence and deep valleys of poverty and a varied landscape of 金博宝188bethealth care spending.It is a hilly terrain of income inequality.

The Affordable Care Act was based on homogeneity.Not only would its provisions be disseminated equally,but smoothing the peaks and valleys of 金博宝188bethealth care utilization would liberate the funds necessary to finance it.Under reform,Newark would come to resemble Grand Junction CO,and Mayo would be the model for Manhattan.No longer would Los Angeles,home to the nation's largest concentration of poverty,consume more resources than Green Bay,WI,where poverty is infrequent.Regional variation in income and poverty could be ignored all together.The problem is "practice variation," and 金博宝188bethealth care reform will fix that.

Of course,the US  is not homogeneous,and poverty cannot be ignored.In fact,Read more »

*This blog post was originally published atPHYSICIANS and 金博宝188betHEALTH CARE REFORM Commentaries and Controversies*

Income Inequality And Its Effect On 金博宝188betHealth Care Spending

(注意:After a five month absence from posting comments,I offer this observation,with more to come.There's much to do.)

The message resonating from the Wall Street protesters is that income inequality doesn't work.And among the developed nations,theUS is the most unequal.This distinction does not come without cost.The greatest,of course,is the social cost borne by those who are poor.But what the protesters may not fully realize is that another is the high costs of 金博宝188bethealth care.This is because the costs of caring for the poor are much greater.And together with the rising numbers of poor patients,they are crushing the 金博宝188bethealth care system.

This notion may seem shocking,since it is generally believed that low-income patients receive less 金博宝188bethealth care.After all,many have little or no 金博宝188bethealth insurance,and most have poor access to primary care.Isn't it the wealthy whose access is best and who use the most?The answer isRead more »

*This blog post was originally published atPHYSICIANS and 金博宝188betHEALTH CARE REFORM Commentaries and Controversies*

Childhood Education May Be The Key To Reducing 金博宝188betHealthcare Costs

In a recent op-ed in theSan Francisco Examiner,William Dow,a professor of 金博宝188bethealth economics at UC Berkeley, commented on the importance of education as a means of enabling more people to afford health care insurance.In my view,education is important not simply because an educated population can more easily pay for 金博宝188bethealth care.The main importance is that educating children will allow those children and their children to have 金博宝188bethealthier childhoods,less burden of disease as adults,access to more personal and communal resources to deal with whatever disease they have and less need for 金博宝188bethealth care,and that translates into less 金博宝188bethealth care spending.Let me frame this in terms of the San Francisco Bay Area.

In a series of articles in theContra Costa Timeslast year,Susanne Bohan and Sandy Kleffman described the striking differences in life expectancy in poor vs.wealthy ZIP codes in East Bay.Life-expectancy in Walnut Creek (94597) was 87.4 years,but it was only 71.2 years in Sobrante Park (94603),where household incomes are about half and poverty >20%.That's a gap of 16.2 years.We find that,in addition to a shorter life-expectancy in Sobrante,the inpatient hospital utilization rate is double the rate in Walnut Creek.Poverty is not only tragic.It's expensive.Read more »

*This blog post was originally published atPHYSICIANS and 金博宝188betHEALTH CARE REFORM Commentaries and Controversies*

Another Look At Geographic Variation In Poverty And 金博宝188betHealthcare

MedPAC has releasedanother reportin which they have tried to explain variation in 金博宝188bethealthcare utilization among metropolitan statistical areas (MSAs),of which there are approximately 400.MSAs more-or-less correspond to Dartmouth's 306 hospital referral regions (HRRs),and the conclusions reached by the Dartmouth folks and MedPAC tend to correspond.Incommenting about MedPAC's last report,issued in December 2009,I noted that the major variation was caused by high Medicare expenditures in seven southern states,where patients are poorer and sicker and use much more care.

In their new report,MedPAC went a step beyond measuring expenditures,which they adjusted for prices and other factors in their last report,to measuring the actual units of service,a far better way to assess the 金博宝188bethealthcare system.MedPAC's new findings on the distribution of service use in MSAs are graphed below:

Based on this new approach,MedPAC concluded: "Although service use varies less than spending,the amount of service provided to beneficiaries still varies substantially.Specifically,service use in higher use areas (90th percentile) is 30 percent greater than in lower use areas (10th percentile);the analogous figure for spending is about 55 percent.What policies should be pursued in light of these findings is beyond the scope of this paper,which is meant only to inform policymakers on the nature and extent of regional variation in Medicare service use.However,we do note that at the extremes,there is nearly a two-fold difference between the MSA with the greatest service use and the MSA with the least."Read more »

*This blog post was originally published atPHYSICIANS and 金博宝188betHEALTH CARE REFORM Commentaries and Controversies*

Primary Care,Poverty,And Mortality In England And America

It is an article of faith that,inBarbara Starfield's words,adults whose regular source of care is a primary care physician rather than a specialist have lower mortality,even after accounting for differences in income,and she draws upon studies at both the county and state levels to prove it.Now a new paper inJAMAabout England's Primary Care Trusts refocuses the discussion on poverty.

While Starfield's county-level studies are often cited as evidence that more primary care physicians and fewer specialists lead to lower mortality,they actually showed virtually no differences at all.And when repeated by Ricketts,the small differences noted were not consistent throughout various regions of the U.S.On the other hand,"counties with high income-inequality experienced much higher mortality." So,in reality,the county studies demonstrated the strong impact of poverty and the marginal impact (if any) of primary care.Read more »

*This blog post was originally published atPHYSICIANS and 金博宝188betHEALTH CARE REFORM Commentaries and Controversies*

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It's no secret that doctors are disappointed with the way that the U.S.金博宝188bethealthcare system is evolving.Most feel helpless about improving their work conditions or solving technical problems in patient care.Fortunately one young 金博宝188betmedical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of 金博宝188betmedical students residents and new physicians as they explore ideas for transforming 金博宝188betAmerican health care delivery.I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It's Real?

I m often asked to do book reviews on my blog and I rarely agree to them.This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem's New Book May Depress You

When I was in 金博宝188betmedical school I read Samuel Shem s House Of God as a right of passage.At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine.I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction.Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student.However after being approached by the authors' PR agency with the promise of a…

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