• The depressing history of medical cost containment

    As told by Steven Schroeder in a recent Archives of Internal Medicine article (h/t Brad Flansbaum):

    During my professional lifetime I have witnessed a succession of individual cost containment strategies, each theoretically legitimate but each doomed to failure because they were either insufficient as a single intervention or ran up against political opposition to vigorous implementation.

    Schroeder then runs through them. Near the end of the brief article, he contrasts the US and European models of care with the following anecdote:

    During a 1982-1983 sabbatical in London, England, I visited a number of European teaching hospitals, meeting with medical staff and accompanying them on rounds. Patients on the medical wards were similar to those at US teaching hospitals. But when I visited the ICUs, it was different: the proportion of special care beds was smaller, and the patients were less sick. I was struck by the relative absence of the extremely ill patients seen so commonly at American teaching hospitals, typically supported for many of their vital functions and often with terminal illnesses. When I asked about this, there were embarrassed silences, and then someone who had spent time in the United States would explain the difference. “I loved being a fellow at X medical school. The facilities were state-ofthe- art, the teaching was superb, and the atmosphere was stimulating.” Then there would be a pause, and the physician would finally explain, “But you don’t know when to stop.” As I began to understand these cultural differences, it seemed that at every step along the referral chain the United States had more powerful forces pushing toward greater intensity of care.

    Schroeder is a former president of the Robert Wood Johnson Foundation (fuller bio here).

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    • This is in keeping with the story that Tyler Cowen and Robin Hanson tell, that Americans think differently about these things.

      A lot of wasted money on something like this does do one positive thing, it demonstrates that their is demand for a solution that does work. I think of the story of SoftRAM. It came out as a scam product but it sold well and so QuaterDeck made a competing product that actual did what SoftRAM said it did.

    • Is there any statistical data to support this? I’m rather leery of anecdotal evidence.

    • It appears the full text of Schroeder’s article is available to subscribers only — understandable, but a pity; from Austin’s brief quotes, it sounds interesting and important.

      Based only on the second block quoted by Austin, it seems certain that this will once again raise the specter of rationing and death panels.

      Why do Americans and Europeans differ on this issue? Is there any realistic hope of changing American attitudes?

      • I wish I had the freedom to provide an ungated version of every paper I cite. But, that would violate copyright. There are tricks to getting a paper. Authors often gladly share reprints, for example. You can connect the dots.