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Thursday, October 19th 2006

More On The New York Times' Coverage

Health Affairs (the magazine) blog is a little less critical of the Dr. Leonhardt work which was published in the New York Times yesterday, than say Matthew Holt.

Leonhardt uses a quote from Jonathan Skinner, a health care researcher at Dartmouth College, to sum up the problem: “Basically, anything that doesn’t kill patients is paid for by Medicare and insurance companies.” In February, Skinner was the lead author on a Health Affairs paper that looked at the rapid decline in mortality from heart attacks from 1986 to 2002. As David Cutler and Mark McClellan had in earlier work, Skinner and his Dartmouth colleagues Douglas Staiger and Elliot Fisher found that on an aggregate basis, the mortality gains more than justified the cost increases over the period.

But the really interesting stuff was going on below the aggregate level. Notably, regions with the largest spending increases were not the areas with the largest spending gains. It turned out that in the Dartmouth team’s view, the factors really driving the mortality gains were low-cost interventions such as aspirin and beta-blockers, not at all the same factors driving the spending increases. Some regions adopted these low-cost, cost-effective interventions more quickly than others, so in any given year, high-spending regions tended to have worse outcomes. Eventually, the cost-effective interventions were adopted widely (although not widely enough) and brought widespread mortality gains, resulting in the favorable aggregate cost-benefit trade-off found by Cutler and McClellan.

My original post.