A Reanalysis Of Gawande's Research

McAllen, Texas is the mother ship for the Medicare National Bank. A culture of care that is bankrupting our country. Or so we think. The ladies and gents over at the Health Care Blog analyzed the data. And came to a very different conclusion.

McAllen is different from many areas of the United States: it is sicker and poorer. The observed differences in the rates of chronic disease are highest for those conditions rampant in low income American populations: diabetes and heart disease. Further, Medicare beneficiaries in McAllen have significantly higher rates of co-occurring chronic conditions. As a result the costs of caring for McAllen Medicare population appears high in comparison to other areas but not abnormally so. McAllen suffers from a tremendous burden, but it not caused by its physicians: the care they provide leads to costs that are substantially comparable to the other counties in the article once adjustments are made for the magnitude of the health problems they face. The disturbing pattern of physician practices uncovered by Dr. Gawande sounds a warning not because it foretells a McAllen-like future but because it portrays the on-going crisis that affects both McAllen and Grand Junction and it is national in scope. Physician culture is only part of the McAllen story.

They did some great analysis of the data to come to these conclusions. They showed that the expenditures out of McAllen in patients without diabetes, heart disease or heart failure was not out of the ordinary.

My own analysis? Before I could conclude that an over treat culture of care in McAllen doesn't exist, I would like to see the data, not on patients without these three diseases, but rather expenditure data on patients WITH diabetes, heart failure and heart disease and corrected for poor status (who's poor health is directly related to smoking status). These are the patients for which medical care is expensive. These are the proceduralized patients. Telling me that healthy folks in McAllen cost no more than healthy folks in Colorado doesn't mean anything. Tell me a rich diabetic with heart failure and a history of MI costs more in McAllen than in Colorado. Now, that's meaningful information.