- A death row inmate wants to donate a kidney. Texas won’t let him.
- How well does Paxlovid really work?
- Casey Mulligan and Joe Grogan defend PBMs. (WSJ)
- More on surprise bills: they occur in one in five emergency room visits and up to one in six in-network hospital stays.
- The Baduy, an indigenous group in Indonesia, have rejected vaccinations. Their Covid death toll: zero. (NYT)
- More on circadian rhythms: mice live longer if they eat on the right time schedule. (DMN)
Category: Doctors & Hospitals
What Difference Does Health Care Make?
Robin Hanson’s classic article comes to this conclusion:
Perhaps the most striking puzzle in health policy is the apparent lack of an aggregate empirical relation between medical care and health. Observed variations in medical care typically have an insignificant effect on average population health, even when looking at large data sets, sets larger than those which convinced most researchers of the reality of many other influences on health.
Big Pharma Blames Hospitals and PBMs for High Drug Prices
Adam Fein at Drug Channels pointed me to a June 2022 report from the Pharmaceutical Research and Manufacturers of America (PhRMA) on the price of drugs. The report is full of tidbits on drug spending. For example, the report states that prescription drug spending represents only 14% of health care expenditures. It is true that drugs are the best value in health care (especially over-the-counter drugs but that was not in the report). While it is true that drugs tend to be a better value than, say hospitals, not all drugs are of equal value. (That too was not in the report.)
What Doctors are Doing, and Why
Is the practice of medicine being dictated by billing codes?
Several decades ago … physicians wrote “notes” on their patients…. every patient had a chart, and physicians would make notes following each patient encounter, capturing such elements as past medical history, the story of the present illness, the findings of physical examination and laboratory testing, and plans for further diagnostic evaluation and care. This approach required the physician to think everything through and formulate a coherent plan. In a sense, every physician was a storyteller, and one of the signs of excellence was the ability to formulate a succinct but comprehensive and coherent account of the patient’s care.
Today, by contrast, a great deal of the medical record is composed by selecting items from lists of available choices and drop-down menus…. And in most cases, the lists of options are constructed as much or more for coding and billing purposes—making sure the practice or hospital complies with regulations and gets paid—as they are to foster good patient care.