Two communities, two tales of health care costs

In The New Yorker, Atul Gawande, M.D., looks at how the United States can contain the rising cost of health care by examining the experiences of towns on both ends of the spending spectrum.

He first looks at McAllen, Texas, which he describes as “the most expensive town in the most expensive country for health care in the world.”

He found that McAllen has remarkably advanced health care technology but “there’s no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country.”

Over dinner with six McAllen doctors, Gawande learned that one reason health care there is so expensive there is that doctors “were racking up charges with extra tests, services, and procedures.” He consulted an economist and looked at Medicare data to confirm that patients in McAllen get more abdominal ultrasounds, bone-density studies, stress tests and other procedures. Gawande also talked to hospital administrators who, like many people in their positions, were unaware of data showing that more costly treatment is not necessarily better treatment.

Gawande then looks at Grand Junction, Colo., which is one of the lowest-cost markets in the country that has achieved some of Medicare’s highest quality-of-care scores. He explains that the medical community there has agreed to “a system that paid them a similar fee whether they saw Medicare, Medicaid, or private-insurance patients, so that there would be little incentive to cherry-pick patients. They also agreed, at the behest of the main health plan in town, an H.M.O., to meet regularly on small peer-review committees to go over their patient charts together. They focussed on rooting out problems like poor prevention practices, unnecessary back operations, and unusual hospital-complication rates.”

Other health systems have implemented similar approaches with similar results. Gawande describes the dichotomy of McAllen and Grand Junction as the “battle for the soul of American medicine.”

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