Cooperating for better care.

Aaron E. Carroll

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Deconstructing Americans’ relative lack of access to health care

October 24, 2016by Robert Whitcomb in Uncategorized tagged , ,

This New York Times article looks at why Americans have less access to healthcare than much of the rest of the Developed World.

One reason the author, Aaron E. Carroll, M.D., notes is:

“The United States, for all its spending, has fewer general practitioners per population than any of these other countries. In 2013, America had half as many primary care physicians per 1,000 people as the next-closest country (Sweden) and one-fifth the number in France or Germany.

“There’s an element of supply and demand here. When you have too few primary care physicians, it won’t be as easy for patients to see them. When you give more people insurance, this problem will only get worse, when many new patients try to access the health care system.”

He doesn’t mention the cost  and access effects of U.S. physicians being by far the highest paid in the world.

To read The Times’s article, please hit this link.

A plea for saner residents’ hours

February 16, 2016by Robert Whitcomb in Uncategorized tagged , ,

 

Aaron E. Carroll, M.D.,  a pediatrician, makes a modest plea for saner hours for medical residents and a look at the dangers of misplaced pride.

He concludes: “Asking residents what they think {about long hours} may not be the best way to determine if that’s the case. Residency programs have a way of indoctrinating new recruits into believing that misery is somehow noble.

“A better metric, and one that we should all care about, is whether resident surgeons are less well trained and skilled when they come out of residency now than before. I’ve heard plenty of anecdotes to support this notion from colleagues, but I’ve seen no good evidence to prove it. Without good data, it feels more like the usual griping each generation seems to have about being the last great one.

“The concerns of those training physicians are valid and should not be ignored. However, if patients aren’t harmed and education doesn’t suffer, we should probably err on the side of treating our doctors-in-training as benignly as possible. As I’ve discussed before, depression and other mental health problems are already common enough during training. We want to be sure that as we create doctors, we aren’t sacrificing human beings.”

 

Eyebrows raised about rising neonatal admissions

July 28, 2015by Robert Whitcomb in Uncategorized tagged , , ,

neonatal

Rising admission rates for even full-term and normal-weight babies into neonatal intensive care arouse concerns that NICUs are being overused. Is this just waste or is there fraud being perpetrated by hospitals and physicians that see this care as a good revenue source?

“If hospitals want to argue that NICUs are necessary, they will need to prove that the need exists, especially in light of the increasing share of infants admitted who are at or near full term,”  wrote Aaron E. Carroll, M.D., from the Center for Pediatric and Adolescent Comparative Effectiveness Research and the Center for Health Policy and Professionalism Research at Indiana University.

More information=less treatment

March 3, 2015by Robert Whitcomb in Uncategorized tagged , ,

Austin Frakt, a health economist, and Aaron E. Carroll, M.D., a pediatrician write about how patients would opt for less treatment if they had more information. They’re responding to an article in JAMA Internal Medicine, the first  to “systematically review the literature on the accuracy of patients’ expectations of benefits and harms of treatment. They examined over 30 studies that assessed whether patients understood the upsides or downsides of certain treatments. To a great extent, patients didn’t.”

Consider that in ”the 34 studies that assessed understanding of benefits, patients overestimated their potential gain in 22 of them, or 65 percent.”

The two writers go on: ”Why do patients err in assessments of risks and benefits? One reason could be that what they know is driven by the messages they hear. Doctors, direct-to-consumer ads and the media can skew our perceptions. They tend to focus on the benefits, but rarely quantify them. healthcare centers, screening advocacy programs and pharmaceutical ads all push us to talk to our doctors about getting treatment without talking about actual gains.”

 

 

 

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