Friday, October 26, 2012

Added to my lexicon: Supply-sensitive care

Fascinating sentences from John Wennberg's Tracking Medicine: A Researcher's Quest to Understand Health Care:
Supply-sensitive care is not about a specific treatment per se; rather, it is about the frequency with which everyday medical care is used in treating patients with acute and chronic illnesses. Here I am talking about physician visits; referrals for a consultation, home health care, and imaging exams; and admissions to hospitals, intensive care units (ICUs), and skilled nursing homes... 
This category, which accounts for roughly 60% of Medicare spending, may be difficult to grasp because it runs counter to the widespread belief that medical interventions are driven by explicit medical theories and scientific evidence. Most of us, including most doctors, believe that a physician makes decisions such as when to schedule a patient with diabetes for a follow-up visit, for example, or when to hospitalize a patient with chronic heart failure, or when to call in an infectious disease specialist for a patient with a fever, on the basis of medical science, augmented by some combination of experience and wisdom. As it turns out, medical science is virtually silent on such matters.  
There is another factor that influences such decisions. As Figure 1.3 illustrates and the book will demonstrate, physician decisions regarding supply-sensitive care are strongly influenced by the capacity of the local medical market—the per capita numbers of primary care physicians, medical specialists, and hospital or ICU beds, for example. (In the jargon of economics, the market is in disequilibrium—supply pushes demand or utilization.) This may seem deeply counterintuitive, and the effect of supply on professional behavior by and large goes unrecognized by physicians, who are unaware of the effect that capacity has on their decisions. But in the absence of a constraining professional consensus on best practices, and under the cultural assumption that more care is better care, available resources are used up to the point of their exhaustion.
Only on chapter 2, but this book has been full of eye-opening arguments and data so far.  

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