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Sunday, December 20, 2009

Regulatory blunt force trauma

I came across a very interesting series are papers published in the Journal of Legal Studies in June of 2001. They were a series of articles published on the impact of managed care and the papers were compiled by one of my "heros", Richard Epstein, author of Simple Rules for a Complex World. If you have not read this book, it is really worth a look.

The feature paper was by David Hyman and it was entitled "Health Care Fraud and Abuse: Market change, social norms, and the trust of reposed in the workman".

There were accompanying critiques which were critical of Hyman's analysis at some levels, but were in general agreement overall. The summary of the critique by Arti Rai sums things up clearly:

"... that health care fraud control is largely a catchphrase that is being used to divert attention from the much more difficult task of allocating health care resources in a manner sensitive to both cost and quality"

In the almost 10 years since these papers were published, there has been a major push to address the issues of efficient allocation and quality. That is the good news. We should be concerned with cost and quality. However, what tools are available to accomplish these goals. There appears to be a sentiment that the same sort of administrative tools which were deployed (with marginal success) to reign in "fraud and abuse" can be used to deal with quality and cost.

I know that the product of these interventions will focus on what can be readily measured. This data will take on a life of its own, being analyzed almost exclusively by those totally divorced from clinical encounters. While these measures will start out as surrogates for actual desired endpoints, they will quickly become the only endpoints that matter for reward.

1 comment:

  1. Agree. Can't really measure medical quality so we'll use easily countable nonsense measures instead as a substitute. As you point out, this data will soon become the official definition of medical quality. Silly. It's hard to measure and rate any art. Should we judge sculptures by their weights just because this is easy to do?