13 thoughts on “Week 1: The Cost Conundrum – Atul Gawande”
A devastating critique of capitalism and exploitation in the form of an article about the US healthcare system?
I am not really surprised that the mix of poverty, heavy drinking, tex-mex food and amoral, predatory business practices applied to the provision of healthcare leads to a very negative outcome. Maybe there should be a system whereby citizens could elect people from their number who would enact laws designed to guard against the worst of human excess and greed?
The simple point that more healthcare does not equal more health is well made, but depressing. Even if the “good news” is that huge amounts of waste in the system offers scope for cost reduction and improvement it’s important to remember that the “fat” is comprised of people’s money, time, energy and emotion. It’s maybe a little cynical to make the point that essentially says that when people live on their knees showing them how to stand is progress.
The whole concept of for-profit, entrepreneurial medicine is just a disaster.
The Mayo clinic’s approach to healthcare isn’t something that can be “copied” without a fundamental alignment of goodwill between the doctor and the patient. Basically, if your doctor doesn’t have your best wishes at heart and is profiteering from your illness, that’s a fundamental problem. You could look at the Mayo clinic’s system as more of a belief system or ethos – underpinned by good working practices, tools and information.
It is very interesting to see a comparison between two similar cities in terms of healthcare costs, and their different point of views around the US system.
There are two points that I want to highlight about this article:
- They are focus more in HCP and their responsibility in the over-costs of healthcare system. I consider that this is a circle, where patients are government are also included. For the system to work, all three should be synchronized. If the government applies hard laws about wrong procedures or left without any arguments to HCP, they are always going to be afraid to diagnose with thousands of exams, that sometimes are unnecessary and the costs of healthcare insurance will growth and there will be no way to decrease the costs.
- The other important thing is about the business. Healthcare shouldn’t be taken as a business, doctors are doctors, not business mans; and this is generating the problem of hierarchy. For me, the patient should always be first, their needs and their insurance situation. I like the Mayo Clinic’s business model to offer their HCP a salary in order to put the patient needs first.
Health care costs have a big impact on America’s fiscal health, but the health care system is very complex with many stakeholders that have different motivations. This article discusses two extremes and why they came to be that way – high health costs in towns like McAllen, where doctors run their practices in a way that focuses on increasing business rather than helping patients, versus lower health costs in “accountable care” health systems like Mayo Clinic and the medical community that evolved at Grand Junction.
The point that health care debates are too focused on who pays rather than on encouraging the adoption of effective existing systems that minimize health care costs – is brilliant. I agree with the position of rewarding the leaders who build upon the “accountable care” model, where doctors are paid on salary and work together with the interests of patients at heart.
To me, it feels almost intuitive that the doctors that truly care about their patients could deliver high quality care with lower costs. The focus would be on long term and preventative care, rather than treating short term symptoms through drugs, extra check-ups, and surgery. It could be argued that a patient’s financial health affects their overall health, and therefore in that sense, ethical doctors should strive to minimize the costs for their patients. Patients put an enormous amount of trust in doctors are responsible and do what is best for them. I am willing to believe that doctors who work so hard succeed in their profession want the best for their patients. But a system that prevents doctors from doing so, or over-incentivizes them to betray that trust, should be changed for the better.
Atul Gawande argues the core issue with the U.S medical system is that it financially rewards doctors for quantity of treatment over quality. And there’s no way to determine if a doctor’s motives are for patient or for profit. Gawande states we can address this problem by establishing a culture of “accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering.”
The question we are left with is how do we do that? As long as medicine operates under this capitalistic model, the Mayo model will never come close to overtaking the McCann approach. Gawande even states he’s “surprised the McCann model isn’t more prevalent.” To enact change, it’s going to take a lot more than a few “anchor” hospitals that are instilling best practices in their communities; it’s going to require systemic overhaul of the entire operation.
From my very peripheral understanding of Obamacare, I was under the impression that attempts were made to address some of these issues from within the system. A doctor friend explained to me, in a very general manner, that the new policies sought to align the interests of multiple health parties including hospitals, physicians, and pharmacies. Part of the plan was to force them all to share in a fixed amount of money paid out by an insurance company for the treatment of a given patient. If any one party requires an excess of money in treating a particular patient, they take away from the money paid out to the other two. For example, if a hospital over-prescribes tests, the patients primary care physician and the pharmaceutical company involved would suffer financially from the hospital’s excess. On the other side, if a patient is readmitted to a hospital for a previously treated health problem (possibly due to inadequate treatment or poor patient health behavior after being released), an insurance company will not pay out additional monies; all parties would bear the burden of this repeat treatment and all would suffer as a result. Theses situations are riddled with nuances, but the overall point was an attempt to create a system of checks and balances that would promote only the best and necessary care.
I thought this article showed a good range or realities that health care systems can face. Sadly, the best solution seemed to be less health care. As I read this I was reminded of an excerpt from the book “Super Freakonomics”. They discuss how instances where health care professionals went on strike and mortality rates dropped significantly. “When there are too many physician-patient interactions, the amplitude gets turned up on everything, more people with nonfatal problems are taking more medications and having more procedures, many of which are not really helpful and a few of which are harmful.” It is easy to see how the “business” of medicine does not fit well with the interest of patients. This situation is made worse by seeking “answers” from a doctor. Western society sometimes turns to doctors and medicine as though it is the only route to a solution.
To better health care system for patients, it is necessary to build a dynamic system to communicate between person-person and network sites. That system reduces the time doctors spend and their efforts for physical duties. Also, check a real patient conditions through their self-monitoring for their own health condition on regional information network. One core organization governs rests of health care structures and prohibit any unreasonable costs from needless medical systems.
This article shows with great clarity the misguided focus that dogs the debate about healthcare. In making the kind of insurance the centerpiece of the problem, a deeper ill is all but ignored. Dr Gawande conveys the power and consequence of the wrong kind of incentives on behaviour. Having said that, the incentive system existed equally for Mayo, but the mindset and culture seemed to make the difference. The question then is if changing the incentive system alone would make a real difference, as doctors of the McAllen ilk would end up gaming the system for their ends. Atul Gawande’s ends with the idea of accountability and the sense I got is that unless someone is penalized in some ways for the current practice of overutilization, there is no reason for anyone to stop what they are doing. At the same time, a change in culture from medicine as business back to patient-interest and the Mayo model is in order. Dr Gawande mentions somewhere in the article that while not all doctors in McAllen put profits before the patient, in the 90’s as this began, no one tried to stop it either. Using peer pressure, group dynamics and social incentives so that there is also a social cost for doctors who transgress medical ethics could be a powerful way to keep these practices in check.
in america, a doctor’s fee is measured by the quantity of service, not its quality — or even its effectiveness. atoll gawande’s investigation into mcallen, texas reveals america’s problem with exorbitant health care costs is a system built around a culture of individualism and business. doctors are paid “as individuals, rather than as members of a team working together” and the practice of paying by service rather than result have created an environment with monetary incentives for doctors to do more in terms of number of procedures but less when it comes to patient outcome.
while most of the arguments around health care in america today revolve around private vs. public insurance, gawande eloquently demonstrates that quality, lost-cost care in america can be found at health centers that promote team work, shared information, and open data; combined with a payment system of pooled income split as a salary amongst employees of the health center (further promoting team work, and reducing the number of excessive treatments and services often charged by individual doctors). accountability, openness, and teamwork are part of the solution to america’s ineffective and crippingly expensive health care system.
health is often defined as the “absence of disease”. but health is more than just the lack of disease or infirmity — it is “a state of complete physical, mental and social well-being” as officially defined by the world health organization (WHO). meaning health is more than just a check up when you are sick, it is a sum of daily behaviors and activities that maintain balance for you mentally, socially, and physically.
but patients today are regarded as the passive players to the active role of doctors when it comes to their health. under the scope of health as merely “minimizing illness” our health care system has become reactive; it responds to disease rather than seeking to prevent it (after all prevention isn’t profitable for a doctor). hugh dubberly argues that self-management reframes patients as designers; shifting the burden of responsibly to the patients letting them set goals and measure progress.
never before has self-care been such a viable and vibrant path to better understanding and promoting our health. lower costs in technology mean cheaper sensors and tracking technology available for the public. our ability to collect and process large data sets can better inform individuals through feedback loops and improve the quality of their health. social media platforms are creating communities of support around disease that are helping individuals learn more about themselves and successful methods discovered by others.
but as rajiv meth points out these tools need to be simple and integrated (people do not need or want another chore). the design challenge is to create a system that unobtrusively collects and represents personal data in a meaningful way. the power of self-data and micro feedback loops to change behavior is immense. visualizing big data lets people find patterns within the noise; and if individuals track their own data, aggregated together this is a large and powerful data set. not only for patients but for doctor’s to better understand the cause and effect of their own practices.
Below is a consolidated reply to all the articles!
I really enjoyed how all the readings covered different aspects of the same perspective. In the cost conundrum reading, I was horrified and surprised to find that the healthcare system was setup for doctors to act more and more like businessmen. To be honestly, I’m not at all familiar with the healthcare system, but it really surprises me how such a broken system, one that has such a huge impact on the lives of millions can go through so many years without change.
I grew up in Taiwan where the healthcare system is more efficient. Even as a non-citizen, I still go home for inexpensive full physicals and wisdom tooth removals. The price differences and quality of care I get is shocking. Typically at home, almost all practices accept insurance, making a visit that could cost $30 no more than $3. If I want more specialized health, I simply book whatever specialist I need. They are usually working in a hospital, accessible by all. Some doctors may have more patients and longer waits, but for the most part skill and experience does not make a doctor less assessable.
Some of the other readings also made more aware of the struggle between facts, causation, and correlation. Doctors aim to find the cause of an illness, but as many of the readings have said, so many of our daily activities slowly tip the scales of our homeostasis. I was reminded of episodes of House, where some extremely obscure activity or disease was plaguing an individual and only by knowing the whole and complete story of the person’s life could they be saved. I feel, with self-tracking, one finds many correlations between daily activities and one’s health output. In psychology we’re always taught to be careful of correlation, but I think this process, until technology catches up is going to be part art and part science.
It’s also interesting to me because in most of East Asia exists the strong beliefs in prevention and alternative care. So, especially with the elder generation. I remember my parents saying that surgery is the absolute last resort because that is killing you as much as it will save you.
One area, I don’t think is tackled well at home or here is psychological health. Another two halves of a whole. After reading about the guy that tracked his mood along with his daily tasks has made me want to try it out. I get the impression most of this is for those who suffer from depression, but I’m thinking of tracking my mood as well. In taking psychology, one of the key things I learned is that I am far from unique. There is a consistency to most of who I am. If it weren’t the case, I probably couldn’t related to any other human.
I have a secret wish to be able to know the statistics of everything, and after reading the data-driven life, where the writer describes self-tracking a tool not for optimization, but discovery, I feel encouraged to attempt self-tracking. I just need to start with a goal. (Sanity vs. Sleep levels at ITP?)
The narrative arc of the article took me on a wild ride of anger and confusion and a sense of hopelessness. It brought it all together nicely for me, by summing the problem up as so:
“Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.”
It’s all about the incentive, and my attitude toward the problem (because my age allows me to be for now) is similar to my attitude towards fossil fuels – the sooner the whole system crashes the sooner we can get around to doing it the right way. It’s not the best attitude to have, but it’s just another example of why people are ready for the pitchforks when it comes to the government. The good news is that there are actions we can take now to be proactive and preventative with our own personal health.
This article illustrated the world of healthcare as a for profit industry in McAllen, Texas. The doctor’s focus was on–getting patients to see more specialists, take more tests, have more in-office visits, and have more surgeries rather then conserving costs. Physicians see their practices as a revenue source. They buy scanning machines, taking cash for operations, and divert insurance payments to themselves rather than the hospital.
In the context of this course, American motto stated in the article: “more is better” stood out to me. I guess that means– the more medical attention we have the more we can monitor our health and prevent diseases (i.e. “the check-up”). This turns out to be the opposite in McAllen; which gives its citizens an extreme amount of medical attention but still reflects a population with a high rate of obesity, heart disease, and various other health problems.
It became apparent to me we use hospitals as self-monitoring systems, especially when a doctor persuades us to, as in the case of McAllen hospitals. We often ignore everything until we feel sick. We then go to the doctors do tests, follow up visits, and scans to measure our health. In this case we are using the hospital as a monitoring system rather than giving patients tools to monitor themselves. There is a disconnect between the patients-knowledge of the costs of these visits and the helpfulness these visits do to prevent sickness.
If we can develop systems that allow us to monitor our health on a daily basis (rather then relying on our self perception) it seems feasible that we can lower medical costs significantly in the realm daily medical visits, tests, scans and so on. It would be interesting to see how a community would treat severity of going to a hospital if they were required to have self monitoring systems. I wonder how much we can reduce basic medical care costs by providing people with these preventive systems. Developing a universal health-monitoring device might be an interesting prototype to make for this class.
-the across-the-board overuse of medicine
-income per capita
-reliable health care system
-foreign-trade zone
-affordable cost to everyone
These sentences are what I chose from the reading. I believe theses sentences are belonged to every other countries’ concerns of health care systems.
As this reading empathized that spending more money for the health insurance gives quantity of health care outwardly, but actually patients get from that expenditure are not equal to that high costs, even they are still forced to suffer from side effects, such as over-does medicines, or unnecessary medical cares.
To better health care system for patients, it is needed to build a dynamic system to communicate between person-person and network sites. That system reduces the time doctors spend and their efforts for physical duties. Also, check a real patient conditions through their self-monitoring for their own health condition on regional information network. One core organization governs rests of health care structures and prohibit any unreasonable costs from needless medical systems.
I enjoy reading Atul Gawande’s writings. But one thought that stuck in my head the whole time I was reading this was the core idea behind his 2011 New Yorker article “The Hot Spotters.” A key fact in that article is that a minority of patients account for a majority of health care expenses. In the cities featured, 5% of the population accounts for 60% of the expenses.
Nonetheless, his point in this article about “less is more” when it comes to tests is interesting. It clearly illustrates that doctors are working “the machine” for pure profit and with less interest in their patients’ well-being.
ACOs have been presented as an alternative to our current system. I was struck however by a comment I heard from Jay Parkinson (founder of HelloHealth.com) during his speech at General Assembly this summer. He claimed that in limited tests, ACOs actually only reduce costs ~3%. This article presents a much brighter picture about the potential of a new system to bring health care costs under control while increasing quality.
But Gawande’s analogy of the health care system operating like a general contractor instead of an electrician paid per outlet installed is a logical and convincing one. “The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.”
A devastating critique of capitalism and exploitation in the form of an article about the US healthcare system?
I am not really surprised that the mix of poverty, heavy drinking, tex-mex food and amoral, predatory business practices applied to the provision of healthcare leads to a very negative outcome. Maybe there should be a system whereby citizens could elect people from their number who would enact laws designed to guard against the worst of human excess and greed?
The simple point that more healthcare does not equal more health is well made, but depressing. Even if the “good news” is that huge amounts of waste in the system offers scope for cost reduction and improvement it’s important to remember that the “fat” is comprised of people’s money, time, energy and emotion. It’s maybe a little cynical to make the point that essentially says that when people live on their knees showing them how to stand is progress.
The whole concept of for-profit, entrepreneurial medicine is just a disaster.
The Mayo clinic’s approach to healthcare isn’t something that can be “copied” without a fundamental alignment of goodwill between the doctor and the patient. Basically, if your doctor doesn’t have your best wishes at heart and is profiteering from your illness, that’s a fundamental problem. You could look at the Mayo clinic’s system as more of a belief system or ethos – underpinned by good working practices, tools and information.
It is very interesting to see a comparison between two similar cities in terms of healthcare costs, and their different point of views around the US system.
There are two points that I want to highlight about this article:
- They are focus more in HCP and their responsibility in the over-costs of healthcare system. I consider that this is a circle, where patients are government are also included. For the system to work, all three should be synchronized. If the government applies hard laws about wrong procedures or left without any arguments to HCP, they are always going to be afraid to diagnose with thousands of exams, that sometimes are unnecessary and the costs of healthcare insurance will growth and there will be no way to decrease the costs.
- The other important thing is about the business. Healthcare shouldn’t be taken as a business, doctors are doctors, not business mans; and this is generating the problem of hierarchy. For me, the patient should always be first, their needs and their insurance situation. I like the Mayo Clinic’s business model to offer their HCP a salary in order to put the patient needs first.
Health care costs have a big impact on America’s fiscal health, but the health care system is very complex with many stakeholders that have different motivations. This article discusses two extremes and why they came to be that way – high health costs in towns like McAllen, where doctors run their practices in a way that focuses on increasing business rather than helping patients, versus lower health costs in “accountable care” health systems like Mayo Clinic and the medical community that evolved at Grand Junction.
The point that health care debates are too focused on who pays rather than on encouraging the adoption of effective existing systems that minimize health care costs – is brilliant. I agree with the position of rewarding the leaders who build upon the “accountable care” model, where doctors are paid on salary and work together with the interests of patients at heart.
To me, it feels almost intuitive that the doctors that truly care about their patients could deliver high quality care with lower costs. The focus would be on long term and preventative care, rather than treating short term symptoms through drugs, extra check-ups, and surgery. It could be argued that a patient’s financial health affects their overall health, and therefore in that sense, ethical doctors should strive to minimize the costs for their patients. Patients put an enormous amount of trust in doctors are responsible and do what is best for them. I am willing to believe that doctors who work so hard succeed in their profession want the best for their patients. But a system that prevents doctors from doing so, or over-incentivizes them to betray that trust, should be changed for the better.
Atul Gawande argues the core issue with the U.S medical system is that it financially rewards doctors for quantity of treatment over quality. And there’s no way to determine if a doctor’s motives are for patient or for profit. Gawande states we can address this problem by establishing a culture of “accountable-care organizations, in which doctors collaborate to increase prevention and the quality of care, while discouraging overtreatment, undertreatment, and sheer profiteering.”
The question we are left with is how do we do that? As long as medicine operates under this capitalistic model, the Mayo model will never come close to overtaking the McCann approach. Gawande even states he’s “surprised the McCann model isn’t more prevalent.” To enact change, it’s going to take a lot more than a few “anchor” hospitals that are instilling best practices in their communities; it’s going to require systemic overhaul of the entire operation.
From my very peripheral understanding of Obamacare, I was under the impression that attempts were made to address some of these issues from within the system. A doctor friend explained to me, in a very general manner, that the new policies sought to align the interests of multiple health parties including hospitals, physicians, and pharmacies. Part of the plan was to force them all to share in a fixed amount of money paid out by an insurance company for the treatment of a given patient. If any one party requires an excess of money in treating a particular patient, they take away from the money paid out to the other two. For example, if a hospital over-prescribes tests, the patients primary care physician and the pharmaceutical company involved would suffer financially from the hospital’s excess. On the other side, if a patient is readmitted to a hospital for a previously treated health problem (possibly due to inadequate treatment or poor patient health behavior after being released), an insurance company will not pay out additional monies; all parties would bear the burden of this repeat treatment and all would suffer as a result. Theses situations are riddled with nuances, but the overall point was an attempt to create a system of checks and balances that would promote only the best and necessary care.
I thought this article showed a good range or realities that health care systems can face. Sadly, the best solution seemed to be less health care. As I read this I was reminded of an excerpt from the book “Super Freakonomics”. They discuss how instances where health care professionals went on strike and mortality rates dropped significantly. “When there are too many physician-patient interactions, the amplitude gets turned up on everything, more people with nonfatal problems are taking more medications and having more procedures, many of which are not really helpful and a few of which are harmful.” It is easy to see how the “business” of medicine does not fit well with the interest of patients. This situation is made worse by seeking “answers” from a doctor. Western society sometimes turns to doctors and medicine as though it is the only route to a solution.
To better health care system for patients, it is necessary to build a dynamic system to communicate between person-person and network sites. That system reduces the time doctors spend and their efforts for physical duties. Also, check a real patient conditions through their self-monitoring for their own health condition on regional information network. One core organization governs rests of health care structures and prohibit any unreasonable costs from needless medical systems.
This article shows with great clarity the misguided focus that dogs the debate about healthcare. In making the kind of insurance the centerpiece of the problem, a deeper ill is all but ignored. Dr Gawande conveys the power and consequence of the wrong kind of incentives on behaviour. Having said that, the incentive system existed equally for Mayo, but the mindset and culture seemed to make the difference. The question then is if changing the incentive system alone would make a real difference, as doctors of the McAllen ilk would end up gaming the system for their ends. Atul Gawande’s ends with the idea of accountability and the sense I got is that unless someone is penalized in some ways for the current practice of overutilization, there is no reason for anyone to stop what they are doing. At the same time, a change in culture from medicine as business back to patient-interest and the Mayo model is in order. Dr Gawande mentions somewhere in the article that while not all doctors in McAllen put profits before the patient, in the 90’s as this began, no one tried to stop it either. Using peer pressure, group dynamics and social incentives so that there is also a social cost for doctors who transgress medical ethics could be a powerful way to keep these practices in check.
in america, a doctor’s fee is measured by the quantity of service, not its quality — or even its effectiveness. atoll gawande’s investigation into mcallen, texas reveals america’s problem with exorbitant health care costs is a system built around a culture of individualism and business. doctors are paid “as individuals, rather than as members of a team working together” and the practice of paying by service rather than result have created an environment with monetary incentives for doctors to do more in terms of number of procedures but less when it comes to patient outcome.
while most of the arguments around health care in america today revolve around private vs. public insurance, gawande eloquently demonstrates that quality, lost-cost care in america can be found at health centers that promote team work, shared information, and open data; combined with a payment system of pooled income split as a salary amongst employees of the health center (further promoting team work, and reducing the number of excessive treatments and services often charged by individual doctors). accountability, openness, and teamwork are part of the solution to america’s ineffective and crippingly expensive health care system.
health is often defined as the “absence of disease”. but health is more than just the lack of disease or infirmity — it is “a state of complete physical, mental and social well-being” as officially defined by the world health organization (WHO). meaning health is more than just a check up when you are sick, it is a sum of daily behaviors and activities that maintain balance for you mentally, socially, and physically.
but patients today are regarded as the passive players to the active role of doctors when it comes to their health. under the scope of health as merely “minimizing illness” our health care system has become reactive; it responds to disease rather than seeking to prevent it (after all prevention isn’t profitable for a doctor). hugh dubberly argues that self-management reframes patients as designers; shifting the burden of responsibly to the patients letting them set goals and measure progress.
never before has self-care been such a viable and vibrant path to better understanding and promoting our health. lower costs in technology mean cheaper sensors and tracking technology available for the public. our ability to collect and process large data sets can better inform individuals through feedback loops and improve the quality of their health. social media platforms are creating communities of support around disease that are helping individuals learn more about themselves and successful methods discovered by others.
but as rajiv meth points out these tools need to be simple and integrated (people do not need or want another chore). the design challenge is to create a system that unobtrusively collects and represents personal data in a meaningful way. the power of self-data and micro feedback loops to change behavior is immense. visualizing big data lets people find patterns within the noise; and if individuals track their own data, aggregated together this is a large and powerful data set. not only for patients but for doctor’s to better understand the cause and effect of their own practices.
Below is a consolidated reply to all the articles!
I really enjoyed how all the readings covered different aspects of the same perspective. In the cost conundrum reading, I was horrified and surprised to find that the healthcare system was setup for doctors to act more and more like businessmen. To be honestly, I’m not at all familiar with the healthcare system, but it really surprises me how such a broken system, one that has such a huge impact on the lives of millions can go through so many years without change.
I grew up in Taiwan where the healthcare system is more efficient. Even as a non-citizen, I still go home for inexpensive full physicals and wisdom tooth removals. The price differences and quality of care I get is shocking. Typically at home, almost all practices accept insurance, making a visit that could cost $30 no more than $3. If I want more specialized health, I simply book whatever specialist I need. They are usually working in a hospital, accessible by all. Some doctors may have more patients and longer waits, but for the most part skill and experience does not make a doctor less assessable.
Some of the other readings also made more aware of the struggle between facts, causation, and correlation. Doctors aim to find the cause of an illness, but as many of the readings have said, so many of our daily activities slowly tip the scales of our homeostasis. I was reminded of episodes of House, where some extremely obscure activity or disease was plaguing an individual and only by knowing the whole and complete story of the person’s life could they be saved. I feel, with self-tracking, one finds many correlations between daily activities and one’s health output. In psychology we’re always taught to be careful of correlation, but I think this process, until technology catches up is going to be part art and part science.
It’s also interesting to me because in most of East Asia exists the strong beliefs in prevention and alternative care. So, especially with the elder generation. I remember my parents saying that surgery is the absolute last resort because that is killing you as much as it will save you.
One area, I don’t think is tackled well at home or here is psychological health. Another two halves of a whole. After reading about the guy that tracked his mood along with his daily tasks has made me want to try it out. I get the impression most of this is for those who suffer from depression, but I’m thinking of tracking my mood as well. In taking psychology, one of the key things I learned is that I am far from unique. There is a consistency to most of who I am. If it weren’t the case, I probably couldn’t related to any other human.
I have a secret wish to be able to know the statistics of everything, and after reading the data-driven life, where the writer describes self-tracking a tool not for optimization, but discovery, I feel encouraged to attempt self-tracking. I just need to start with a goal. (Sanity vs. Sleep levels at ITP?)
The narrative arc of the article took me on a wild ride of anger and confusion and a sense of hopelessness. It brought it all together nicely for me, by summing the problem up as so:
“Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.”
It’s all about the incentive, and my attitude toward the problem (because my age allows me to be for now) is similar to my attitude towards fossil fuels – the sooner the whole system crashes the sooner we can get around to doing it the right way. It’s not the best attitude to have, but it’s just another example of why people are ready for the pitchforks when it comes to the government. The good news is that there are actions we can take now to be proactive and preventative with our own personal health.
This article illustrated the world of healthcare as a for profit industry in McAllen, Texas. The doctor’s focus was on–getting patients to see more specialists, take more tests, have more in-office visits, and have more surgeries rather then conserving costs. Physicians see their practices as a revenue source. They buy scanning machines, taking cash for operations, and divert insurance payments to themselves rather than the hospital.
In the context of this course, American motto stated in the article: “more is better” stood out to me. I guess that means– the more medical attention we have the more we can monitor our health and prevent diseases (i.e. “the check-up”). This turns out to be the opposite in McAllen; which gives its citizens an extreme amount of medical attention but still reflects a population with a high rate of obesity, heart disease, and various other health problems.
It became apparent to me we use hospitals as self-monitoring systems, especially when a doctor persuades us to, as in the case of McAllen hospitals. We often ignore everything until we feel sick. We then go to the doctors do tests, follow up visits, and scans to measure our health. In this case we are using the hospital as a monitoring system rather than giving patients tools to monitor themselves. There is a disconnect between the patients-knowledge of the costs of these visits and the helpfulness these visits do to prevent sickness.
If we can develop systems that allow us to monitor our health on a daily basis (rather then relying on our self perception) it seems feasible that we can lower medical costs significantly in the realm daily medical visits, tests, scans and so on. It would be interesting to see how a community would treat severity of going to a hospital if they were required to have self monitoring systems. I wonder how much we can reduce basic medical care costs by providing people with these preventive systems. Developing a universal health-monitoring device might be an interesting prototype to make for this class.
-the across-the-board overuse of medicine
-income per capita
-reliable health care system
-foreign-trade zone
-affordable cost to everyone
These sentences are what I chose from the reading. I believe theses sentences are belonged to every other countries’ concerns of health care systems.
As this reading empathized that spending more money for the health insurance gives quantity of health care outwardly, but actually patients get from that expenditure are not equal to that high costs, even they are still forced to suffer from side effects, such as over-does medicines, or unnecessary medical cares.
To better health care system for patients, it is needed to build a dynamic system to communicate between person-person and network sites. That system reduces the time doctors spend and their efforts for physical duties. Also, check a real patient conditions through their self-monitoring for their own health condition on regional information network. One core organization governs rests of health care structures and prohibit any unreasonable costs from needless medical systems.
I enjoy reading Atul Gawande’s writings. But one thought that stuck in my head the whole time I was reading this was the core idea behind his 2011 New Yorker article “The Hot Spotters.” A key fact in that article is that a minority of patients account for a majority of health care expenses. In the cities featured, 5% of the population accounts for 60% of the expenses.
Nonetheless, his point in this article about “less is more” when it comes to tests is interesting. It clearly illustrates that doctors are working “the machine” for pure profit and with less interest in their patients’ well-being.
ACOs have been presented as an alternative to our current system. I was struck however by a comment I heard from Jay Parkinson (founder of HelloHealth.com) during his speech at General Assembly this summer. He claimed that in limited tests, ACOs actually only reduce costs ~3%. This article presents a much brighter picture about the potential of a new system to bring health care costs under control while increasing quality.
But Gawande’s analogy of the health care system operating like a general contractor instead of an electrician paid per outlet installed is a logical and convincing one. “The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.”