doc, do everything you can!
The NYT reports on a study suggesting that
increased health care spending doesn't actually lead to increases in healthiness:
But nothing, Dr. Wennberg says, is so counterintuitive as the peculiarities that keep cropping up in the use of medical services. Whether it is the frequency of visits to a doctor or how often people have diagnostic tests or how much time people with chronic diseases spend in intensive care units or how often they are hospitalized, the data are consistent, he says: the greater the supply, the greater the use.
If medical care were just another commodity, the opposite would happen, he notes. "In areas where there are too many doctors it would be like areas where there are too many McDonald's," Dr. Wennberg said. Offices would be half-empty, doctors would see fewer patients.
Instead, without even realizing it, doctors in such areas simply see their patients twice as often, monitoring their conditions ever more closely, Dr. Wennberg said. Yet he and others say there is no evidence that patients in these regions are healthier. His colleague Dr. Fisher noted that four large studies of Medicare patients, by the Dartmouth group and three others, found no improvement in mortality in areas that spend more.
This actually isn't so "counterintuitive" if you believe the following (all of which seem plausible to me):
(1) Increases in health care beyond a certain point don't increase health very much. For instance, the difference in health between (say) getting a physical once a year and getting a physical once a month is probably negligible for most people.
(2) People are hypochondriacs and tend to overestimate the benefits of additional healthcare. ("Doc, do everything you can!")
(3) To the extent health care is paid for (e.g. by
Medicare), the cost of "consuming" health care is simply the inconvenience of obtaining it. If the number of doctors doubles, you can get twice as much health care for the same cost (inconvenience).
These all differentiate doctors' offices from McDonalds, though the third is likely the key difference. I'm surprised the article doesn't point that out. Actually, since it's the NYT, I'm not surprised.
