07 April 2010

Healthcare corner #13 - Final wrap-up

last class! done with class!

mostly a wrap-up class (with cake!) we reviewed the last lecture, summarized what we had learned in the class overall, and then the students briefly presented their final papers. their assignment was to do a "mythbuster" similar to the ones offered on the canadian website i mentioned last time. and, not surprisingly, due to the u.s. health care reform and the interest of many of the students in our debates, several of them chose mythbusters related to "u.s. v canada" things.

myth topics of students who compared u.s. style health care to canadian health care included:

-"profitable delivery of health care is of a higher quality than its not-for-profit counterpart"
(her research found that not-for-profit is at least as "quality," if not better, than for-profit health care. she also mentioned that she had her american roommate proofread her paper. she said he was very stubborn about believing her findings and even though she had research articles to support her words, he was unable to accept that what he was reading could be accurate. he was much more comfortable going with his "gut" than with trying to adjust his views in light of this new information he was reading.)

-"the publicly funded, not-for-profit canadian health care system wastes administrative dollars while the american privately funded for-profit system is forced to reduce costs to be competitive and is more administratively efficient" (this was kind of an easy one because any expert will tell you this is definitely a busted myth, but the student who did this had found some excellent evidence. interesting items: approximately 20% of for-profit insurance dollars go to executive bonuses. even private hospitals have to spend administrative dollars on advertising and bonuses.)

-"canadians are flocking to the united states for necessary medical care to avoid dying on long wait lists in canada" (her evidence found that most canadians treated in u.s. hospitals are those vacationers [or the wintering "snowbirds"] who need emergent care while visiting the u.s. for pleasure. rarely are people purposely coming to the u.s. specifically for "better" or faster care.)

-"more cardiac care is better for the heart" (spurred on by the premier of newfoundland traveling to florida for cardiac surgery, her evidence found that while cardiac care in the u.s. tends to fall into the "more aggressive" category in terms of higher use of technology, medication, and surgeries to treat problems, there wasnt any evidence that this improved outcomes.)

one last thing we talked about in class was the u.s. "RAND health insurance experiment." had heard mentions of this before but never looked into it. very interesting. it was a large-scale, randomized experiment conducted between 1971 and 1982 in the u.s. 2,750 families were randomly assigned to one of five types of health insurance plans created specifically for the experiment. there were four basic types of fee-for-service plans: one type offered free care; the other three types involved varying levels of cost sharing — 25 %, 50 %, or 95 % coinsurance (the percentage of medical charges that the consumer must pay). The fifth type of health insurance plan was a nonprofit, HMO-style group cooperative (this plan was given free to the participants assigned to it). you can go read more about it, but some of their findings were interesting...
- participants who paid for a share of their health care used fewer health services than a comparison group given free care. this resulted primarily from participants deciding not to initiate care (is using less health care good?).

- cost sharing reduced the use of both highly effective and less effective services in roughly equal proportions. cost sharing did not significantly affect the quality of care received by participants.

- cost sharing in general had no adverse effects on participant health, but there were exceptions: free care led to improvements in hypertension, dental health, vision, and selected serious symptoms. these improvements were concentrated among the sickest and poorest patients.

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