Sunday, May 21, 2006

Crisis of Abundance: "Premium Medicine"

As a fitting sideline of my glamorous and thrill-filled life as a tax accountant, I am blogging my reading of "Crisis of Abundance," Arnold Kling's new book on health care economics.

Mr. Kling identifies "premium medicine" as the culprit for the continuing increase in healthcare costs. "Premium" medicine describes the routine use of high-tech diagnostic tools and specialists in everyday health care. While the book lays out statistics on this, it hit home best for me when he explained it in terms of one patient's odyssey in dealing with an eye inflammation. He discusses how the "Quixote's" inflammation would have probably been treated 30 years ago:

In this case, the patient might have been sent home with an antibiotic and perhaps a prescription for Prednisone, a steroid used to reduce inflammation. There would have been nothing else to do. In 1975, computerized medical imaging technology was new and exotic, with limited applications.

In contrast, in 2005, over the course of a few days Quixote was given a computed tomography scan, referred to a specialist, sent to a different hospital, referred to a specialty clinic, seen by a battery of specialists there, and given yet another CT scan. Ultimately, however, she was sent home, as she might have been 30 years ago, with an antibiotic, Prednisone, and no firm diagnosis.

I hadn't given much thought to this aspect of health costs - the way that even relatively routine health problems are made more expensive by the application of specialists and technology. I had always thought that was more of an issue for emergencies and life-threatening illnesses. Doctors aren't cheap to start with, and specialists probably tend to cost more. Add two CT scans, "a battery of specialists," a second hospital and a special clinic, and you've got one expensive eye inflammation.

It's an interesting problem. This shows that the application of expertise and technology doesn't necessarily change the treatment or the result. Yet in some cases it does - the MRI for the backache patient that identifies an unsuspected cancer in time, for example. I look forward to seeing what suggestions. Mr. Kling has for this.

Prior bookblogging of Crisis of Abundance:

May 20, 2006
May 16, 2006

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