Friday Cat Blogging: Dartmouth Atlas of Dead People edition
The Dartmouth Atlas is a decades-long project that has primarily documented that some dead old people are more expensive than others and that some parts of the country seem to have more expensive dead old people than do other parts of the country.
The "researchers" who have been working on this project have, pretty much, blamed this variation on a combination of two groups of malefactors: 1. there are some greedy old geezers who refuse to go away and die gracefully, and 2. the greedy money-grubbing doctors who service the greedy old geezers who refuse to die.
They assert that all this variation is unwarranted because every part of the country has approximately the same percentage of sick people and approximately the same percentage of poor people. Further, they assert that all this extra care that some people get is wasted, because it was fore-ordained that they were going to die anyway.
Their solutions for this perceived "unwarranted" variation include inventing the Accountable Care Organization (for profit, naturally), and paying doctors more money for providing less care, and shared decision making, and some other ideas that made it into the PPACA that I don't feel like chasing down the links for right at the moment.
Never mind that it's been pointed out that neither poverty nor illness are "evenly distributed," or that counting only the dead people instead of including the ones who survive will give you distorted results, or that yes, spending more money on sick people does increase their chances of survival, or that maybe there are some state-level effects going on too (when even economists at the Federal Reserve can spot flaws in your research...), or that sure, the spending varies widely, but the actual care? Not so much.
Never mind that when "geographic variation" first became a topic of study, measures of how much of the variation could be attributed to the overall health of the population were crude, and that over the years, this estimate has risen from 18% to 29-30% to 45%.
And now we have Geographic Variation in Fee-for-Service Medicare Beneficiaries’ Medical Costs Is Largely Explained by Disease Burden, a study that appears to be credible, claiming that 80% of the variation in Medicare spending is - yes - directly attributable to how healthy any given sub-population is (or is not).
Before you know it, we're going to find out that, while there are some outliers, pretty much, doctors provide appropriate health care all across the US. Maybe one day soon we can actually bury the atlas of the dead, and get on with fixing those things that are truly wrong in our health care system.
In honor of all the zombies everywhere: