From: hrubin@pop.stat.purdue.edu (Herman Rubin)
Subject: Re: Medical Insurance and Cost Efficency
Organization: Purdue University Statistics Department
Date: Mon, 23 Nov 1992 21:03:46 GMT

In article <1992Nov21.045321.23876@netcom.com> rkaplan@netcom.com (Richard Kaplan) writes:
>In article <By1qJp.FII@acsu.buffalo.edu> v128pvry@ubvmsb.cc.buffalo.edu
> (Christophe A Stoner) writes:

>>The only way to stop the skyrocketing
>>costs of Medical Insurance, in my opinion, is to drastically reduce the 
>>number of those in need of major medical attention. Only when we have
>>become more aware of general health in this country can we expect
>>to reduce medical expendeture.

There is quite a bit spent on those needing major attention.  However, this
is not what is driving up the cost.  What is driving up the cost is that
people at the low end of consumption of medical facilities tend to overuse
them.  This is not all their fault; a doctor is far more likely to order or
suggest medical procedures if the patient is paying $10 for them than if the
patient is paying $50 or $100.  So we are faced with what is known in 
economics as the tragedy of the commons.  And with the present cost control
alternatives, the doctor is paid nothing for thinking, searching the literature,
and in other ways using valuable time to come up with alternatives to just
plugging ahead.

Now more intelligent alternates need to be available in many situations.
I do not know how much the "Urgent Care" centers have saved, but there
are many situations where something between ignoring symptoms until a
regular appointment can be made and going to the emergency room of a
hospital are needed.  Probably other intermediates may be appropriate.

There may be situations in which a patient needs a semi-medical situation
before an operation, or when recovering.  Nor does someone need to be in
a hospital room for several hours before surgery.  Even in situations
where urgent attention may be needed, it may not be needed that rapidly
that the person must be in a hospital room.  

>There is a good deal of truth to what you say, particularly
>regarding expensive procedures for elderly, terminally ill patients.
>However, it would be difficult if not impossible to "drastically
>reduce the number of those in need of major medical attention";
>no matter how advanced medicine gets, we will all die one
>day.  All medicine can do is delay this death or perhaps alter
>the cause of death.

Again, some alternatives may be appropriate.  A patient who is not in
immediate danger of death, but needs semi-continuous medical care, may
be better of in some sort of a hospice.  Possibly many levels of this
are needed.  These alternatives do not exist at this time, where someone
may need continual medical care, but still not a hospital situation.

>On the other hand, increased funding for primary care and
>preventive medicine might very well reduce medical costs
>significantly by catching, relatively early, non-life threatening
>but nonetheless serious and preventable/treatable 
>illnesses.

There are two totally different situations discussed here.  Prevention
can be quite costly; too many tests are unlikely to damage health, but
add up.  Also, primary care physicians must have diagnosticians, not
the present specialists, to fall back on.  These need not even be 
physicians, but thinkers.  Thinking is greatly discouraged in our
present society; medical plans seem to pay only for actions.
-- 
Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Phone: (317)494-6054
hrubin@snap.stat.purdue.edu (Internet, bitnet)  
{purdue,pur-ee}!snap.stat!hrubin(UUCP)
Newsgroups: talk.politics.medicine