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.
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?