The Cost Conundrum

In The Cost Conundrum, Atul Gawande, attempts to show that there is no correlation between higher costs for healthcare and the quality of care that a patient receives. Gawande focuses his article on McAllen, Texas, a small town in which most residents earn an average income of $12,000 per year, yet the Medicare program spends $15,000 per enrollee, which is almost twice the national average. The focus of the article is attempts to breakdown who or what is response for this level of spending. It is the health care system, physicians, or insurance companies?

Gawande gives statistics about the medical spending in McAllen and the well being of its residents as compared to its neighbor to the north, El Paso County. The demographics from both areas are similar, yet Medicare spending is half in El Paso County then what it is in McAllen. The driving thought is the possibility of McAllen providing a higher quality of care. Sadly the answer is no. Hospitals in McAllen actually rank lower than those in El Paso country. Gawande had the opportunity to sit down with six doctors that practice in McAllen to discuss his findings. His findings show that the patient’s in the McAllen system were being used as a revenue stream. As one doctor pointed out, “there is overutilization here, pure and simple”.

The findings from his research shows that patients in McAllen are often given unnecessary tests, procedures, and prescriptions in order to receive more money from government programs. Where does the excess go? Into the pockets of the physicians in practice. Gawande even goes so far as to give hypothetical case studies to find how different doctors would treat the individual. The results give a clearer picture and reinforce his early notion that there is indeed an overutilization.

Not all is lost though. Gawande gives light to the Mayo Clinic and how their idea of “the needs of the patience come first” could be what the health care system needs as part of its reform. At the Mayo Clinic it is more of a team effort with the entire staff, including the janitors, sitting in on weekly meetings to discuss the level and quality of care that their patients receive. The first step in setting the Mayo Clinic apart was by changing the way health care was being financed through their facility. By pooling all of the money the hospital and its doctors received, setting all in practice on a salary, it eliminated the financial driven doctors like those in McAllen. The outcome has been positive, higher quality and lower costs. This model has even been adapted by other health systems and hospitals throughout the country.

The concern though is that our financial driven economy will be the downfall of systems like those in place at the Mayo Clinic and that more facilities will follow the path of McAllen, sacrificing quality for income. Gawande hopes that the future holds a “generations of Mayos” and not one of McAllen’s.