In October, This American Life produced two interesting episodes about health interventions and evidence-based medicine that I am just listening to now. These This American Life shows seem fresh and interesting, largely because they try to discuss health insurance/care issues from a quantitative, evidence-based perspective, even though cite few numbers in the episodes. To illustrate this point, part of the first episode is even titled “Every CAT scan has nine lives,” referring to the side effects of over-using advanced medical techniques such as CAT scans.
The More is Less episode is particularly interesting for OR folks. It starts with a twenty-minute discussion of some of the cost and effectiveness problems with health care. The episode steps through one of the problems that grappled the medical community from the 1970s: geographic disparities in hysterectomies and other medical procedures in Maine and Vermont. This baffled the doctors, since the disparities in hysterectomies across the state could not be explained by demographics, age, religion, or other factors, as was initially suspected. One of the doctors who performed some of the analysis (Wennberg) concluded that 70% of women would receive hysterectomies in some communities. Maine doctors concluded that disparities were in part based on the doctors choosing to over-perform certain surgeries rather than the patients asking for procedures.
The episode continues to discuss why performing more medical procedures leads to more side effects and potential destruction in some cases, including the PSA tests for prostate cancer, thus exploring the tradeoff between cost and effectiveness. These issues have been in the news quite a bit lately, particularly with the chance in mammogram screening recommendations. These discussions in the news have included too much pandering and too little math and analysis, for the most part. I’ve struggled to find good resources for a lay audience that address the numbers, so this episode was much appreciated. I’ll leave the rest of the episode a mystery, so you can listen to it yourself. The second episode (Someone Else’s Money) is not nearly as good, but examines health insurance in more detail.
Podcast Links: More is Less and Someone Else’s Money.
Link: The Numbers Guy (WSJ) on Mammogram Math is also an interesting read.
Have you found any good references on lay explanations of the numbers behind health care and health insurance?
Punk Rock Operations Research 
January 31st, 2010 at 9:14 pm
Thanks for the podcast links. I am also trying to get real numbers to comprehend the root problems of the U.S. health care system. The World Health Organization ran a study a few years ago and ranked the U.S. as 37th in the world. This was highly politicized by those who wanted a French type system, especially since France was ranked number one in the study. It took me two days of Googling to find what I think is the report that was promoted (odd that none of the news articles nor blogs for and against I found linked to the report). The U.S showed up as 37th, but the criteria as to why was a little fuzzier. My problems with the paper I read is listed below
1) Of the criteria given for the study, why is “Fairness in Financing” weighted differently than the rest of the criteria ?
2) What is the basis of “Fairness” in the financing ?
3) Why did the list of countries just show the final score and not a breakdown for each criteria. I really wanted to understand why was the U.S. 37th in the world. I am guessing the problem is the “fairness in financing” but I do not have an objective way to determine this from the study.
Maybe you can find better info from the World Health Organization.
The paper that marks the U.S. as 37th: http://www.who.int/entity/healthinfo/paper30.pdf
Other WHO data that may help: http://www.who.int/whr/2008/en/index.html