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Productivity and Medicine

By Matthew Yglesias  

"Productivity and Medicine"

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There’s far too little talk about the problematic role of doctors and the doctors’ lobby in health care policy. I think it’s pretty well-understood in political circles that while teachers will on the one hand be important advocates for education as a policy priority, they’re also going to have interests that aren’t identical with the interests of students or the public at large. The parallel situation with regards to doctors gets much less attention, perhaps because their professional organizations and such aren’t called “unions.”

Throat clearing aside, Ezra Klein points to a study with this striking conclusion:

[A] year after surgical teams at eight hospitals adopted a 19-item checklist, the average patient death rate fell more than 40 percent and the rate of complications fell by about a third, the researchers reported.

Sounds like something we ought to implement!

Oftentimes we just kind of assume that doctors are perfectly benevolent, perfectly knowledgeable people who are doing nothing all day but diligently trying to understand what’s best for patients. Obviously, though, the world doesn’t work like that. And the actual practice of medicine involves a lot of flawed procedures and a general sort of laziness in which practice is guided by habit or by “what was taught in med school when I was in med school” or by considerations of profit rather than by serious research. Ezra says “One of the secrets of health reform is that there’s substantial opportunity within the system to make it cheaper while making it better.” And indeed there is. Much like in other fields of endeavor the key thing is to not merely increases the quantity of health care, but to increase the productivity of the health care sector by using resources more efficiently.

There are real tradeoffs between cost and quality, but the issue of productivity defines the scope of those tradeoffs. At the moment, our medical sector is very inefficient so our cost-quality curve is in a very unfavorable location. A more efficient, more productive sector would give us more appealing tradeoffs. But to get that efficiency you need to actually crack down a bit on the prerogatives of the stakeholders—insurance companies, yes, but also doctors and others.

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