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December 19, 2007

Comments

Yoews

The FISA bloggers and FDL are gross and so's SC and Clinton.

Delete again.

kim

Often those who sacrifice are blind to the ethics.
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Jane

That is truly fascinating.

Annoying Old Guy

Not to dispute the basic thesis, but one must be a little careful with this data. For instance, it might be that higher spending hospitals have lower survival rates because the incoming patients are sicker. Why would that be? Because a hospital might have a reputation for superior results, and so the sickest patients preferentially select that hospital, and the hospital in turns spends more (because the patients need more care) and has worse results (because the patients are more likely to die).

That may not be the case, but it's hardly outside the realm of possibility.

Tom Maguire

For instance, it might be that higher spending hospitals have lower survival rates because the incoming patients are sicker.

That is the same problem cited for doctors whose patients keep dropping, and I am sure there is some truth to it.

The Times article does note VA hospitals that are able to track patients, care, and doctors over long periods, which should allow a better evaluation of a doctors actual skill (relative to luck and patient selection, I guess).

But it is interesting to think about how difficult a problem it is. "Take two aspirin and call me in the morning" does not generate much income, but is sometimes the right treatment. So how does one devise a system that rewards a doctor for making that judgment correctly?

boris

So how does one devise a system that rewards a doctor for making that judgment correctly?

Are doctors to blame because people eat too much expensive steak instead of more healthy and less costly fruits and veggies?

It doesn't seem like there is a simple logical linear relationship. Some make the argument that people have little or no say about their own health and somebody else needs to address an out of control system. I don't buy it. People choose to spend more than they "need" to. Pretending otherwise makes anaysis less credible.

Porchlight

For instance, it might be that higher spending hospitals have lower survival rates because the incoming patients are sicker.

The "natural childbirth" community argues that midwives have better outcome rates than OB deliveries in the hospital. But the same idea applies - the hospitals get all the hard cases, including the many women who get no prenatal care at all, whereas midwives only take low-risk patients and scoot them off to the hospital if anything goes wrong. So of course their outcomes look better.

You would think that educated people could suss this out, but no, earnest midwives and their patients are constantly citing these stats to me as if they are proof that hospitals are "dangerous" places to have babies.

kim

Work for Food.
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