MCN | Medical Consultants Network
The Power of a Second Look
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A man referred to only as Rafael was the recipient of the first full face transplant. The operation, which was done in March, was performed by 30 Spanish doctors in Barcelona. Mr. Rafael underwent the transplant after nine previous operations failed to help his neurofibromatosis, a genetic disorder that caused benign tumors to grow on his face.
With the passage of health reform, we are now seeing frequent reports of its shortcomings. The new legislation still relies upon a private insurance market and the expectation that individuals will buy insurance or suffer penalty. People, especially those with lower incomes, will behave rationally and in what they perceive to be their economic interests. This many for some include preserving scarce cash today, and not focusing on an uncertain and expensive need for future health care. Rather than argue that people should behave responsibly and address future health issues with insurance, this article, from April 20 in the NY Times, and the individuals describes speaks for itself.
This is an important article from the NY Times of April 18, that outlines the relationship between exercise and weight. In a nutshell, it cites research that suggests that dietary intake is the determining factor on weight and the exercise in the absence of intake reduction will have little long-term impact. Mechanisms exist that lead individuals to eat more following exercise, negating the caloric of the activity. Gender differences making loss harder for women is also described.
Physicians from time to time have issues impacting their ability to practice. Many of these issues are temporary, relating to health or substance abuse, skill deficiencies and other matters. Others may become permanent. At MCN in the course of credentialing consultants, we review cases where regulatory action has taken place. This Wall Street Journal article describes one program’s approach to assessment and remediation of physicians who have practice issues leading to regulatory action in California.
From the New York Times on Sunday March 14, this article states the obvious; that avoiding change in the health care system is not an option and that payers will exercise some decision-making and control over what is paid for and permitted. An inherent challenge in any system where the payers are not the consumers is that usual marketplace controls are not present. When we pay ourselves, we generally exercise restraint. In health care it is the rare service that is paid for by the patient. The patient has no particular motivation to not consume, or to shop for price, and the providers have motivation to treat and sell services to the degree that they can be medically justified. An interesting thought experiment would be to imagine a patient seeking or being advised to obtain a given treatment, and then instead of being given the treatment, they are given the money that the treatment would cost at the place they were considering, and told that they have a choice of getting the treatment, keeping the money and foregoing the treatment, shopping for the treatment at a lower cost and keeping the difference, or changing the type and extent of the treatment (for example switching from a brand name to generic drug). Obviously the complex nature of diagnosis and treatment would make decision-making a challenge for many. Furthermore, irresponsible behavior combined with the perverse incentive of keeping the cash would mean that many would take the money and not vaccinate their kids, and generally be more resistant to preventive care where they are not currently suffering or in pain. Health reform proposals as best we can tell, are not meaningfully addressing the excess utilization trends that occur regularly.
