In a recent New Yorker article, Atul Gawande describes McAllen, a small town in Texas, where health spending has spiraled out of control in the past two decades. Gawande characterizes McAllen as a place where the “medical community came to treat patients the way subprime mortgage lenders treated home buyers: as profit centers.” Average per capita spending is more than $15,000 in McAllen, compared to $7500 in nearby El Paso. Much of this discrepancy is attributed to the “culture of medicine” in each of these two cities.
Questions to ponder:
- What role does the “culture of medicine” play in skyrocketing health care costs and should this culture be regulated?
- What responsibility do physicians have to contain health care spending and prevent overutilization of health care services?
- How might accountable care organizations (ACOs) mitigate financial incentives for overutilization and incentivize high quality care without infringing on provider autonomy?
Atul Gawande, The Cost Conundrum, New Yorker, June 1, 2009:
Fisher et al., Foster Accountable Health Care, Health Affairs, 28, no. 2 (2009): w219
Fisher et al., Creating Accountable Care Organizations, Health Affairs, 26, no. 1 (2007): w44-w57