Health care spending is fractal; I won't belabor this point further.
I didn't always think this way, but as I spent more time in "the numbers" of health care and health care finance, this "fact" has became pretty obvious.
My group staffs 5 different emergency departments within a 125 mile radius which means the two furthest facilities are about 250 miles apart.
250 miles may not seem all that far but it in the world of medicine, it is worlds apart. So while a casual observer might think "they're just emergency departments", e.g. plain vanilla, let me add there is actually a world of difference between various vanillas. Or as a friend of mine who runs two emergency departments in Waco Texas likes to often say "all medicine is local".
Each of our department is unique. Not only are the communities and therefore the patients very different, so too are the facilities' staff, the facilities' capabilities,etc... I mean unique.
And as a medical bean counter for my group, where even my own natural tendency is to make everything "process, process, process", this uniqueness poses particular challenges to policy wonks. I can attest.
With that background in mind, reading Maggie Mahar today will make you smile.
Looks like the policy wonks are catching on to the fact that there are a few more levels to the fractal after all. Not only is the doctor the problem, now it's the region's doctors and how they cooperate with each other. Now its the patients.
... I wonder what they would find if they lumped clusters of regions together as well? Would these differ? You know my own view. ;-)
-"We have met the enemy and he is us."
All I can repeat is "all medicine is local" and we docs have know this for a very long time. Changing one person's behavior (like your own when you want to loose a few pounds) is hard enough. Changing entire communities' behavior is something entirely different. Having personally been down this very road many times (and I am only talking about 5 hospitals 250 miles apart where I know all the providers by first name), I can verify that it is really really really hard changing groups of people.
Here is an example: if people would stop shooting each other, this would save a boat load of money. So why not change this behavior?
Yet somehow they wonks think they can change the health provider behavior of entire regions of the country?
Will they use money to change behavior?
Oooohhhh, money! In our evil "money driven medicine" culture? (Sorry, I had to get that dig in, Maggie can be... I'll let it go) Now we will use the root of all evil to solve "their" problem?
PhD policy wonks are so good at seeing the interchangeable nature of people within their own models. I only wish they would cooperate with a few MBAs so they could see that people are not always as interchangeable as they often would like them to be.
Perhaps the military term that comes to mind to best predict what will happen is "fragging".
... And by saying this I most certainly do not want to imply in any way that I will personally "frag" policy wonks in their attempts to change collective behavior. Indeed far from it, I actually really do support their general goals and will try my darnedest to help them out.
But do I think it will work?
Do I think they will change enough people on a regional basis to change regional differences?
I might again ask if we are still shooting each other? Do we still use plenty of drugs as a society?
Are there regional differences in these behaviors? ;-)
I will be very interested to see if the people of New York or Miami will truly be willing to change their own collective attitudes towards uncertainty. Will they become as comfortable as someone from Minnesota with statement from their doctors like: "yes, you might have heart disease but what are we really going to do about it anyway so don't go looking for something that isn't a problem. If you do, you'll save someone else money."
... Indeed in a kind of twisted version of this logic, why not get rid of screening all together? ;-)
All I can say is that Gallipoli comes to mind. (start at 5:35)
I do not think policy wonks see how providers will frag them on this issue which is a shame. Providers are not their enemies.
Think about your own family, what you would be willing to hear a physician tell you and then tell me what you think?
... Or maybe if the physician tells you a different way. After all, physicians do not really serve you, physicians serve the collective. We all know this. ;-)
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