Healthcare economics Archives

How to rid medicine of its cronyism

Michel AccadJune 10, 2018July 9, 2021Articles, Ethics, Healthcare economics, Healthcare policy, Medical practice4 Comments

We just did a fantastic interview with the legendary G. Keith Smith, MD, co-founder of the Surgery Center of Oklahoma.

Early in the interview, Dr. Smith speaks of the motivation that pushed him and his partner, Dr. Steven Lantier to divest themselves from the government-insurance-hospital system back in the late 1990s: They wanted to stop enabling what Smith identified as “financial serial killers,” so-called non-profit institutions that end up charging astronomical prices for healthcare yet have no qualms about bankrupting defenseless patients who are unable to pay those prices.Continue reading “How to rid medicine of its cronyism”

“Real ACOs haven’t been tried yet!”

Michel AccadMay 13, 2018Articles, Healthcare economics, Healthcare policyLeave a comment

What happens when you’re a healthcare policy wonk and the pilot study for your pet program has failed miserably? You declare “Success!” in the editorial pages of the New England Journal of Medicine and demand that the program become nationwide and mandatory.

I kid you not. This is exactly what happens.

Thankfully, Anish Koka is vigilant and explains the blatant obfuscations and manipulations that the central planners engage in to have their way.

In our latest video, we reveal the machinations, take the culprits to task, and discuss pertinent questions regarding health care organization: Does “capitation” reduce costs? Do employed physicians necessarily utilize fewer resources? What happens when a HMO and a traditional fee-for-service health system operate side-by-side in a community?

Enjoy!

Should doctors protect their turf?

Michel AccadApril 26, 2018April 26, 2018Articles, Healthcare economics, Healthcare policyLeave a comment

It’s been a little over a 100 years since medical licensing laws were introduced in the US. If people doubt that slippery slopes are real, they should reflect on that history.

In our latest video, Anish Koka and I discuss a “white paper” jointly written by Jeffrey Flier, former dean at Harvard Medical School, and Jared Rhoads from the Dartmouth Institute, calling for some deregulation of the apparatus that rules the supply of physicians and their scope of work. The paper gives an exhaustive account of the bureaucratic mess and offers some possible remedies.

Anish and I a fun conversation, although we barely scratched the surface of this important topic. Anish is concerned that opening the flood gates willy-nilly without addressing other aspects of the healthcare boondoggle will mainly decrease the quality of care and do little to reduce costs. I feel that Flier and Rhoads are way too timid in their proposals and could at least call for competition among regulatory and accrediting bodies.

We touch on the question of safety, patient sovereignty, alternatives to licensing, and whether protectionism is ever a legitimate option. I’m sure we’ll have occasion to revisit this question. By the way, the can subscribe to the YouTube channel…

Confessions of a pharma-fed doctor

Michel AccadApril 18, 2018April 18, 2018Articles, Ethics, Healthcare economicsLeave a comment

In our latest video, Dr. Koka and I discuss a recent paper in JAMA that starts with the following opening paragraph.

Physicians and teaching hospitals in the United States receive approximately $7 billion from the pharmaceutical industry annually. These payments have been associated with higher-cost, brand-name pharmaceutical prescribing. Whether industry payments are associated with physician treatment choice in oncology is uncertain. We examined the association between oncologists’ receipt of payments from pharmaceutical manufacturers and drug selection in 2 situations where there are multiple treatment options.

Payments to doctors by the pharmaceutical industry are problematic, even if they amount to literally peanuts. But let’s not get distracted by the much greater and more pervasive conflicts of interest that affect implicate everyone in the health care system.

At the end of the clip, I offer my version of the kind of opening paragraph I would love to read in the medical literature (but never do):

Physicians in the United States receive approximately $700 billion from the government and insurance industry annually. These payments have been associated with higher-costs, over-utilization, over-treatment, and decreased quality. Whether government and insurance industry payments are associated with physician treatment choice is uncertain. We examined the association between physicians’ receipt of payments from the government and insurance industry with duration of office visits, quality of care as perceived by the patient, and with utilization of health care resources. The control group was composed of patients who do not accept government and insurance payment for services.

Here’s the clip.

Health insurance is not insurance

Michel AccadJune 15, 2017June 17, 2017Articles, Healthcare economics, Healthcare policy16 Comments

Is health insurance a plan to help healthy people mitigate against an unexpected illness, or an income subsidy to help the sick pay for medical care?

Conservatives ought to have a clear answer to that question. Congressman Morris Brooks from Alabama did not and found himself on the receiving end of liberal ridicule.

By suggesting that those who take better care of themselves should pay lower health insurance premiums, Brooks implied that health insurance is indeed a type of insurance arrangement. After all, the risk adjustment of premiums is a practice proper to all other kinds of insurance services: A prudent driver pays less for auto insurance than one with a pre-existing driving record. A home owner pays more for home insurance if the property is on muddy terrain rather than on sturdy ground. A smoker pays more for life insurance than a non-smoker, as does anyone whose risk of dying prematurely is high, even if that predisposition is inherited genetically.

Brooks’ conception of health insurance, however, intuitive as it may be, is wrong.Continue reading “Health insurance is not insurance”

Good health care news from America

Michel AccadJune 2, 2017September 10, 2021Articles, Healthcare economics, Healthcare policy, Medical practice1 Comment

[I was kindly asked to provide an article for Courrier du Medecin Vaudois, the French language journal of the medical society of the canton of Vaud. The article was published as part of an issue on the theme of ‘America First against Obamacare.’ Below is an English version of the piece.]

Health care in the United States: The surprising good news

On the surface, the news from America about health care seems rather grim: cost and dissatisfaction keep rising, reforms are stalling, and, for some, even life expectancy may be declining. If that wasn’t bad enough, President Trump issued a tweet on March 25 predicting that “Obamacare will explode.”

For a small but growing number of doctors and patients, however, the future is surprisingly hopeful. Continue reading “Good health care news from America”

A health insurance CEO daydreams

Michel AccadApril 4, 2017May 3, 2017Articles, Healthcare economics, Healthcare policy3 Comments

Jim was at his desk, looking weary.

The last few weeks had been brutal. Despite working twelve-hour days, he felt that he had little to show for. His annual board meeting was to take place the next day, and he expected it to be tense.

With a replacement bill for the ACA about to be voted on, and with Trump in the White House, the situation seemed particularly precarious. The board members had asked him to present a contingency plan, in case things in DC didn’t go well.Continue reading “A health insurance CEO daydreams”

Should we blame technology for increased healthcare spending?

Michel AccadJanuary 31, 2017February 6, 2017Articles, Healthcare economics9 Comments

Should we blame technology for the growth in healthcare spending? Austin Frakt, a healthcare economist who writes for the New York Times, thinks so. Citing several studies conducted over the last several years, he claims that technology could account for up to two-thirds of per capita healthcare spending growth.

In this piece, Frakt contrasts the contribution of technology to that of the ageing of the population. Frakt notes that age per se is a poor marker of costs associated with healthcare utilization. What’s important is the amount of money spent near death. If you’re 80 years old and healthy, your usage of healthcare services won’t be much more than that of a 40-year-old person.

So far, so good. But should we accept the proposition that technology is the culprit for healthcare spending growth?Continue reading “Should we blame technology for increased healthcare spending?”

The pharma-fed doctor

Michel AccadJune 20, 2016December 13, 2016Ethics, Healthcare economics, Healthcare policy7 Comments

In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on.

I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the researchers did not determine if there was a cause-and-effect relationship between payments and prescribing.” To deny that perks have a causal effect on physician behavior invites improbable considerations.

In fact, the data suggests that doctors are particularly easy to manipulate. One of the researchers interviewed by Ornstein was “surprised that it took so little of a signal and such a low value meal [to influence doctors]” A Chick-fil-A is all that it takes!Continue reading “The pharma-fed doctor”

In defense of the employed physician

Michel AccadJune 9, 2016March 18, 2017Ethics, Healthcare economics, Healthcare policy6 Comments

I wish to make one clarification and one prediction regarding employed physicians.

The clarification is this: There is a common misconception that if healthcare operated under free market conditions, it would primarily be a cottage industry of solo practices and of small physician-owned hospitals. Such operations would not develop the capabilities of large healthcare entities that we commonly associate with central planning.

In reality, however, the opposite would be the case. Continue reading “In defense of the employed physician”