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Saturday, May 29, 2010

OK, my first short health care thoughts

So here is my first line of thinking...

A little background for those with their head in the sand: municipalities nationwide are approaching bankruptcy.

Nuff background.

And while it is true that spending is spending and therefore ANY spending cuts will help a budget crisis, still I chose to believe that high value spending is not at as great a risk as low value spending. This is my first model assumption.

... For all my cynicism, I truly think it is rare to meet someone who is evil. Selfish people are rather common, evil ones are truly rare.

So with my first assumption, we also know firefighters and in particular EMS represent one of the larger budgetary items in any municipality's budget. Indeed in my own county, EMS spending (which is 85% salaries) has increased almost 100% over the last 8 years while staffing has only increased by about a third (you can guess where the money went).

Well what if I told you there was almost zero evidence that paramedics improve outcomes?

In truth I am over stating my case (a little) as there are a few things that paramedics do which have been shown to improve outcomes (but only a few).

Don't believe me?

Think I'm being "sensational"?

Take a look at the keynote address at their own 2010 Gathering of Eagles Conference. Look at the data yourself.

So I ask again (municipalities are in desperate need of cash, they are spending lots of it on EMS, they are getting very little bang for the buck, etc...): "what would you do?"

PS- To top it all off, most administrative energy in EMS (which is actually quite a few resources) are centered around whether people follow process.

Let me repeat this again so it sinks in: follow process on procedures that add little or no value.

I kid you not.

It matters not whether what is done improves outcomes, it only matters whether process was followed.

You can kill the patient as long as you used the correct procedure. ;-)

Indeed, as I think on what has happened in the world of EMS, perhaps the best financial industry analogy I can think of is the synthetic CDOs on CDSs on sub-prime mortgage backed bonds. The underlying bonds themselves may be worthless (like a lot of EMS procedures) but the energy is focused on the overlying structure of process that rests atop the worthless processes and procedures (like a synthetic CDOs made from worthless CDS on top of worthless bonds, etc...).

You can't make this stuff up.

I will start looking at who supplies EMS when I get some free time. ;-)

PPS- For all my views on America's health care bubble, do not misunderstand me either. I truly think most of the men and women in EMS are heroes. I truly think they do want to help people (whatever else may be going on with their unions, pensions, etc...). I simply also think they can't (though sometimes they do) and that their inability to help is no fault of their own. But no matter how much water you put in your gas tank it will not run your car, so too will throwing money at EMS not help the underlying problem it is trying to solve. Good people get caught up in bubbles along with everyone else.


Thai said...

What a mess...

Dr John said...

It took me a while to get to it but I almost got whiplash nodding in approval with your summary Thai. It is all about pretense not outcome. This is is pure in pt psych business. As I have said to you before on this blog. There is no proof putting people in the psych ward does anything. We burn money. We would be better off using it in the winter instead of coal. Bravo.

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