

What a Texas town can teach us about health care - jakarta
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=true

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TomOfTTB
To me the author makes one fatal mistake in the article and that is assuming
all hospitals could run as well as the Mayo Clinic. The Mayo Clinic is the
best managed medical institution in the country. There are books written about
it's management ([http://www.amazon.com/Management-Lessons-Mayo-Clinic-
Organiz...](http://www.amazon.com/Management-Lessons-Mayo-Clinic-
Organizations/dp/0071590730/ref=sr_1_3?ie=UTF8&s=books&qid=1243324775&sr=8-3)).
Assuming every hospital can match it's efficiency isn't realistic.

Coming up with a universal system for anything requires planning for the worst
possible scenario not the best.

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vidarh
He's given examples of several other healthcare systems that are of similar
low cost and high quality.

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TomOfTTB
I guess I shouldn't have singled out the Mayo Clinic but the same point
applies to McAllen or any other Examplery institution. You can't build a
solution by assuming hospitals will have excellent management because most
won't (which is why the one's who do are considered excellent in the first
place)

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barry-cotter
that if you take enough small pseudo random samples, you'll get one far
outside the norm eventually, by pure chance.

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rml
Anecdote: several years ago, I had some pain in a rather delicate area. I did
some research online before seeing my doctor, and noted several likely causes
for my symptoms. There was one minor ailment which seemed the likeliest
culprit (and was, as it turned out).

In the course of this research, I found that several medical sites based in
the US (WebMD among them) mentioned corrective surgery as a possible remedy.
The UK-based sites I came across made no mention of surgery, only lifestyle
changes and other palliative measures.

~~~
Radix
Did you follow the palliative treatment? Did it solve your problem?

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yummyfajitas
Lots of health care is pointless and has no net health benefit (i.e., benefit
- side effect). But some is useful, and we don't want to cut that portion.
This has been known for years by health care economists, and is ignored by
everyone else.

As far as I'm aware, there is only good filter for determining which medical
procedures are useful: the ones patients are willing to pay for out of pocket.
This was the conclusion of the RAND experiment.

Robin Hansen wrote a great review article on this topic.

[http://www.cato-unbound.org/2007/09/10/robin-hanson/cut-
medi...](http://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-in-
half/)

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sethg
In the UK, the National Health Service pays doctors a flat fee per patient, so
doctors have a powerful incentive _not_ to provide treatment. On international
measurements of how healthy the population is, the UK scores about as well as
the US does (i.e., pretty mediocre for a First World country)--but the UK
spends only 40% as much as the US does for health care.

