Thursday, May 28, 2009

Gawande on Health Care in High Cost Counties

Atul Gawande has written an interesting article about healthcare in McAllen, Texas, one of the highest cost markets in the country. Government payers in the county already predominate because not many people have jobs with private insurance, so that is not a sufficient explanation for its high costs. Moreover, measuring the county’s health outcomes in terms of survival or satisfaction shows no improvement over other counties, so that is unlikely to be the explanation either. Instead, Gawande argues that its problems are a matter of culture.

The blogosphere has already jumped on the tentative implications that the article puts forward for solving our country’s health care problem. But that is not the main thrust of the article by any means. His primary point is to lay out the problems in McAllen and contrasts its state of affairs to the state of counties on the other extreme (such as Rochester, Minnesota, home of the Mayo clinic), where the health care is better but the costs are lower. Through interviews and appeals to statistics, he then tries to put forth a coherent theory for why these differences exist. Instead of debunking its macro implications, we should encourage more micro expositions like this one which we can draw upon if and when we begin redesigning our medical institutions.