1) NEJM: “Sweeping statements about the cost-saving potential of prevention, however, are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs.”
My take: A must-read for Hillary and Obama every politician, who pin their cost-cutting hopes on preventive medicine. It isn’t going to work. Cost cutting means keeping people out of the emergency room and denying tests that are not evidence-based. A more effective approach would come from funding a strong primary care foundation and instituting a national comparative effectiveness program.
2) Rhode Island comes up with a refreshing approach to health reform: address costs first, then access.
My take: They get it right. Massachusetts misguidedly promised access before drowning in costs. Rhode Island is taking the far more sensible approach:
The strategies include emphasizing primary care over emergency care, managing treatment of people with chronic diseases, and paying doctors to keep patients healthier. The proposal would also establish a massive database of healthcare treatments, outcomes, and costs designed to point the way to better care at lower costs.
If costs are addressed, access will follow. Bravo.
3) One out of three infants born in Massachusetts in 2006 were delivered by Caesarean section, the highest proportion ever.
My take: Blame John Edwards the multi-million dollar cerebral palsy cases trumpeted prominently by the media. Obstetricians read the same newspaper and TV stories that we do. In difficult births, life-altering decisions need to be made in seconds. Don’t tell me that the latest cerebral palsy verdicts aren’t a factor in an OB’s decision to go with a C-section. After all, it’s just your career on the line.
Related posts:
- ER visits and health care costs rise in Massachusetts due to lack of primary care access
- Does preventive medicine save money or cost more in the long run?
- Does preventive medicine really save money?
- A doctor posts bail to give an inmate his medication
- The myth that preventive medicine saves money
- Rising childbirth deaths and C-sections
- C-sections and individual insurance
{ 5 comments }
Actually C section rates have been rising for quite a long time. When I sat on med exec committees in the late 90’s and early 20’s, the ideal rate was somewhere below 20%. We were running around 26% at the time and tried everything possible to lower it. Now I think everyone has just given up – the pressures from the patients and litigators are just irresistible. I am not an OB, but would be interested in the clinical risk/benefit analysis of allowing the rate to rise so.
Love change in style with the talking points, Kevin. Keep it up.
Doctors are self-absorbed, opinionated morons. C-section rates have been rising in all states, including those that imposed liability caps. Indeed, they’ve been jumping just as fast in states like TX with caps as those without, like PA. If there were truly a obvious relationship between c-section and liability fear, you’d expect at least a lower rate of increase in the capped states.
The reasons for c-sections go to the way docs are compensated and trained, U.S. doctors have a culture of intervention that leads to useless and invasive procedures.
Why do you think midwifery has grown so much in the last 20 years? They’re from a different treatment culture: one that is perhaps better suited for those desiring natural childbirth
Anon 10:26 – isn’t it a great argument? Just say that doctors are morons, and you’ve made your point!
I wonder if they looked at c-section rates by state and mother’s age. From what I remember, women in MA are the oldest in the nation when they get married. It would make sense that women in MA would be having kids later in life as compared to other states.
My husband is a OB training in MA. He tells me his patients have never been older. It’s amazing how many people are willing to go through fertility treatments and get pregnant at, say 48. Also, excellent hospitals in the Boston area attract a lot of higher-risk patients from New Hampshire, and even Maine (those are at higher risk of having a c-section to begin with).
Kevin, in your reference to the “latest verdicts”, only one was cited, and there’s no evidence the physician’s career was ruined or that his/her insurance did not cover it, or that they even have paid anything. You’re not doing a very good job supporting your claims. Perhaps that’s because the facts aren’t there for your one trick pony of malpractice claimants are the world’s greatest evil?
Comments on this entry are closed.