Weekend Potpourri IV

An article in the Annals of Internal Medicine reports that physicians tend to order more Pap tests than guidelines recommend, which increases costs and likely causes patients’ unnecessary anxiety.  Physicians may be responding to patients’ requests, fearful of malpractice or simply be uninformed about the guidelines.  In any event, studies such as this suggest why preventive care often doesn’t save money.   (Annals Abstract)

Reuters has an article based on the Dartmouth Atlas research, with a focus on the notion that doctors tend to gravitate toward wealthy areas, leaving poorer regions under-served.  The article also repeats the Dartmouth claim that these areas with more physicians don’t get better outcomes and have significantly higher overall spending.  It is worth noting again that there may be methodological problems with the Dartmouth research which would caution against wholesale acceptance of its findings.  (Reuter’s Article)

To show again that one arm of the government frequently ignores another branch, Congress is contemplating revoking health insurers’ antitrust exemption, on the theory that consolidation of insurers has led to competitive abuses.  Yet at the request of Congress, the Government Accounting Office had reviewed the literature and reported earlier this summer that it found little if any adverse effects from private insurer consolidation.  (GAO Report)

The New England Journal of Medicine ran a perspective on promising approaches to controlling health spending.  (NEJM Perspective) The perspective was written by Rand researchers and looked at eight ideas to reduce cost.  They identified bundled payments, particularly for chronic disease, as the one with the most promise, potentially over a 5% reduction.  All-payer hospital rates were also likely to help.  Other techniques, such as disease management, medical homes and value-based benefit design, had less potential to create significant savings, in their view.  The important thing, as the authors note, is that none of these are likely to happen soon or easily.  And for bundled payments in particular, how multiple providers will share the payment is almost an unsolvable problem.

The Medicare Today coalition released a survey on seniors’ satisfaction with Part D drug coverage.  Almost 90% say they are happy with their plan, 60% say very satisfied.  They find the cost to be reasonable and say it meets their expectations.  (Medicare Today survey) The most notable aspect of the survey is that Part D is an entirely private program, there is no “public option”.  It has cost less than projected and the people it serves are satisfied with the plans.  Maybe there is a lesson for health reformers in these responses.

Finally, we are all supposed to be careful where we cough in these H1N1 days, but apparently it could soon be good to cough into your cell phone, just don’t let anyone else use it after you do.  A company claims it has a device which can diagnose your health problem by having you cough into your cell phone.  The firm has a database which matches the sound of your cough to prerecorded ones for various problems.  Don’t laugh too loud, Bill Gates is backing this.  Oh well, maybe it’s better than phrenology.   (Press Release)