“In God we trust; all others must bring data.”
-W. Edwards Deming.
In the discussion about how me might control health care costs while simultaneously improving outcomes on proposed solution is evidence-based care, i.e. using data on what works to suggest (or mandate) treatment options. The usual objection is that no two patients are alike, so there is no substitute for an expert's intuition. However, in an article in the New York Times Magazine, Making Health Care Better, David Leonhardt provides some examples from places such as Intermountain Healthcare where providing doctors with suggested protocols resulted in dramatic improvements in outcomes, such as improving the survival rate for one condition from 10% to 40%. It turns out the providing a protocol can improve outcomes even when the protocol is wrong.
The explanation for this seeming paradox turns out to be that humans are very good a recognizing patterns, but only if they get rapid feedback. By computerizing medical records and analyzing the outcomes, the protocol and the actual treatments can be adjusted based on what works. Also, human intuition is notoriously bad at statistics, which is obvious to anyone who has been to Las Vegas. Following studies that analyzed outcomes, Intermountain reduced the number of newborns with respiratory problems by cutting back on the number of elective induced deliveries.
The article points out that the benefits of evidence-based care are not evenly distributed. While patients benefited, the hospital lost out on a number of highly profitable procedures. In the example cited, the doctor's ethics won out over the profit motive, but in cases where the outcomes might be the same, the hospital did not pass the savings on to the insurance company. But financial incentives are a discussion for another day.
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