12 November 2016

Health Care

So, various persons talking about the probable fate of Obamacare have managed to set me off.

Cost in medicine is driven by three things; time of diagnosis, accuracy of diagnosis, and treatability of the condition.

The first two matter a lot; you want to catch any problems soon and you want to provide the correct treatment for the problem.

It's even better if you can avoid the problem completely; preventative care is better than incidental care is better than chronic care is better than acute care.  Hence the province of Ontario having free flu shots for residents; the flu shots and the publicity are way, way cheaper than the cases of flu you'd otherwise have.  Even if you leave out the "fewer miserable people" and "fewer dead people (who no longer pay taxes or do work)" parts of the calculation; it's cheaper than the lost work time of those who recover.

The key thing to catching problems early is care that's continuous and uncomplicated.  (If you have to fill out lots of forms, odds are you don't want to do it.)

For-profit health care wants to make as much money as possible, so it's in favour of forms (maybe they don't have to pay!) and it's expensive, so people don't go for care until they're afraid they're going to die.  This pushes care to the acute end of the continuum and raises costs.

In other words, a market can't and won't ever work for health care.  It's not a problem you can solve with a market.


orc said...

Sadly, fundamentalists don't do very well with accounting -- if THE MARKET, MAY ALL BLESSINGS FLOW FROM IT! isn't working, it's not the problem of the market but of the people. (It doesn't help that a large swath of the political class in the USA are bigots and sadists who want to see people suffer and die in abject poverty, but they wouldn't be so powerful if they couldn't piggyback off the libertarians and other "free market" evangelicals.)

Graydon said...

Can't argue with any of that. It still croggles me a little that there's so little actual accounting mentioned.

Ross D said...

About a decade ago my excellent family physician in eastern Ontario told me there was no good epidemiology to demonstrate that flu shots for everyone were useful. (He said so as he was giving me the flu shot.) Of course government policy is only rarely informed by science, so perhaps this it not surprising.

But since you chose it as an example I just had to revisit the question. The strongest thing I can find in half an hour is http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001269.pub5/abstract;jsessionid=236F26021E35AD2C9FCFA926F7B3B7E6.f04t02, where the conclusion is that vaccination reduces time lost by maybe 0.04 work days per person. At a mean hourly wage of $25, that's about $8 of productivity saved per shot. The vaccine itself Google says costs about $10-$16, which is unfortunately not "cheaper than the lost work time" but instead pretty much on a par with it.

And that's a shame, because I think your conclusion is nonetheless correct: Prevention is way better than acute care, and for-profit health care pulls the other way. I think the non-economic arguments have to carry the weight, at least in the case of the flu. Flu is a right bastard to vaccinate against, unlike measles, rubella, etc.

Graydon said...

+Ross D
It was about four years ago that my now-retired family physician, as a sort of emendation to asking me if I'd got my flu shot and mentioning that you could get them at pharmacies now, noted that the shift from scheduled-clinics to "all the pharmacies" had been driven by OHIP's tabulation of results. The observed result was in terms of less hospital care, and that had been extrapolated back to how many people got debilitating flu, but they -- OHIP -- were pretty much convinced it was obviously worth it and hadn't been, previously, in the clinic era.

It's entirely possible I misunderstood or mis-remember, but I hope not. :)