Sunday, January 16, 2005

Confusion about medical errors, sigh

A Health Care Cost Shift (
'So we're spending a third more than any advanced industrial country, but half of that money is wasted and people are hurting,' Darling said. 'The employer has to pay more just to undo the damage done' by medical mistakes.

There's no evidence that the US has a higher medical error rate than other wealthy nations. In fact, based on my experience in Canada, our error rates are probably about the same or a bit lower than elsewhere. (It's not that US physicians are more virtuous or better trained, it's that US consumers are more aggressive and have more lawyers.)

This is not a chance bit of confusion. It's a deliberate smokescreen by the insurance companies and payors. Of course journalists at the Washington Post are readily bamboozled by this kind of thing.

We know from studies in the 80s and 90s why our costs are higher than other nations. We use more subspecialists, we pay far more in overhead to payors and insurance companies, we're more aggressive in neonatal and end-of-life care, we pay our physicians and nurses more than other nations. (Note we pay our CEOs far, far more than other nations). It's no great mystery.

Reducing medical errors might reduce costs -- it depends how you define "error". In the popular sense of a "mistake that causes harm" reducing those might increase costs! Most the mortality from medical errors comes near the end of life, to vulnerable people who can't survive commonplace mistakes. Since most of those people would die even with perfect care, medical errors are reducing costs. (This is a common mistake about medical errors btw. The years-of-life-lost to medical error are far less than years-of-life-lost to other causes.)

If by "error" one means duplicate testing, "unnecessary care" (MRI for sore shoulder -- one man's luxury is another's necessity), etc. then indeed reducing these "medical errors" would reduce costs. That's in part what "managed care" is about. It's not what Leape et al were writing about in the 80s and 90s when they made their mark.

Of course there's no way any journalist will get this straight. They have been betrayed by their publishers/editors and are massively outgunned by the insurance/payor industry.

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