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« Bestseller | Main | How green was my valley »

May 30, 2009


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This looks to me as just another principal-agent problem which is fostered in many ways and places of the modern 21st lifestyle.

Disconnection from what keeps you alive is potentially unhealthy(Duh!)


It's not difficult to ferret out the original sin in the model. In an efficient market model, two parties benefit from an agreement. The patient gets his care and the sickcare professional receives a fee for his opinion or expertise. When a model is constructed which involves an agent/broker for both parties in a transaction, a less than noble coefficient must be factored into the agreement. Add to this the blessings of Nixon after it was described as a benefit to private enterprise by Ehrlichman, you have the mother of all conservative approval(Alien sci-fi model). Even Agnew had doubts about the morality of providing less care for the same price to increase profits. He was dispatched quickly enough.


The model needs to start with the goal - Smith's classic butcher or baker would be to maximize their revenue, and the customer wants to maximize their consumption. It is easy to see how their goals align and you get cheaper meat & bread and the b&b's can simultaneously increase profit...you may also get fat customers.

Part of Mayo's importance to the article is how their focus is on maximizing health, which is the patient's goal also. A lot of the change can be driven through medicare. One activity I heard about was not paying for some stenting if the generally accepted care for a particular patient is another course (details sketchy). Electronic medical records will help if it can generate anonymous care reports - patient with these symptoms & this history received this care, with this outcome.

There's a common idea in medicine - eat what you kill. It's where docs get paid according to how much business they drive. The comeback from that article would be that philosophy yields unnecessary killing and carcasses going to waste.

Greensboro is towards the bottom in cost. Raleigh is 50% higher in 'hospital care intensity' than Durham. How many Durham residents travel to Raleigh for care, opposed to vice-versa?

This article should kill the idea that more care always equals better care.

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