Tag Archives: health

how to optimize your health care dollars

The Chicago Tribune had an interesting article on how to spend less money on health care. Their advice: use fewer health care resources. The rationale is that the list of things that we know help us live longer is “pretty short.” So quit smoking, exercise, and only spend money on the essentials. Here is what they claim is the list of essentials:

•Skip the annual physical examination. “It’s an unnecessary expense,” said Dr. Ranit Mishori, a family physician who teaches at Georgetown University School of Medicine.

•If you have a cold or an upset stomach, ask if your doctor will do a phone visit. “There may be a charge, but it may be less than even the co-pay for an office visit,” [Dr. Emily] Gottlieb said.

•If your doctor proposes an expensive imaging procedure, such as an MRI for the pain in your knee, ask what it’s for. “If the outcome of the test won’t change the treatment plan, why do it?” Mishori said.

•Instead of a colonoscopy to screen for colorectal cancer, you could opt for an inexpensive test for blood in the stool. “If there’s something wrong, you can follow up with colonoscopy,” Mishori said.

•Consider having a mammogram every two years. “We don’t have any evidence that doing it every year is better than every other year,” [Dr. Ned] Calonge said.

•Ask if you can have a Pap test once every three years. “If you’re over 30 and have had three normal Paps in a row, that shouldn’t be a problem,” said Dr. Linda Hughey Holt, an obstetrician-gynecologist in Skokie. “Only women at increased risk for cervical cancer need annual Paps. And those who have had a total hysterectomy don’t need them at all.”

•Drop your health club membership and walk a mile a day instead. “We know that exercise is very important to prevent diabetes and heart disease,” Gottlieb said. “It’s also important for people who are depressed. But there’s no need for a trainer or a lot of fancy machines.”

•Ask about cheaper equivalents of your prescription drugs. Some chain pharmacies, including Wal-Mart and Target, have $4-a-month prescription plans for the most common generic drugs. You may be able to substitute lovastatin at $4 for Lipitor, which costs about $140.

•For dental work, continue regular checkups to avoid long-term, expensive problems. If you have good oral hygiene and no history of problems, you can consider increasing the intervals for cleanings and X-rays, some experts say. As a general rule, adults usually can delay cosmetic dentistry and orthodontia. But in children, “early orthodontia can save money later,” said Dr. Robert Sandusky of Evanston.

•Talk to your doctor about dropping your cholesterol medication altogether, especially if you’re over 85. The consequences of high cholesterol aren’t felt for 10 or 15 years, Gottlieb said, so pausing or even stopping treatment may not significantly affect your health.

•Insist that your health care providers use the latest operations research innovations so that they can provide the same level of service for less.

OK, so I made up that last item, but wouldn’t that be cool? Many economists have noted that we spend so much for health care in the US because we pay for unnecessary treatment. I don’t know enough to make a comment, but the list looked pretty reasonable to me. What do you think?

OR and the food system

A few weeks ago, I caught a couple minutes of a Michael Pollan interview (the Omnivore’s Dilemma) on Bill Moyers Journal. It was fascinating, but I was tired, so I turned the TV off and went to bed. I just got around to listening to the podcast. Pollan mentions several issues in the interview that have OR implications.

  1. Food is cheap in the US. But cheap food is very expensive when taking the whole system into account (food transportation, type II diabetes, other health problems). Looking at the whole system is necessary to understand the costs. Pollan claims that food processing requires 10 calories per calorie consumed(!)
  2. Food security is a big issue when our food system is centralized. It is easy to contaminate our food supply when so much food is processed in one location. This is not a new issue, but may have an OR solution. Lawrence Wein talked about the issue at the INFORMS annual meeting (Wein wrote a paper about botulism in the milk supply).
  3. Pollan is very critical of the school lunch program since it is used to get rid of food surpluses, which means that students are fed junk food. This really gets me riled up since my oldest child is almost old enough to start school. Pollan advocates spending $1 per student per day to increase the nutritional value in school lunches. Here’s the kicker. As part of the solution, a certain fraction of this extra $1 should be spent within 100 miles of the school in order to meet many social goals (increasing nutritional value of school, reviving the local economy, supporting local agriculture, reducing our dependence on the amount of fossil fuels to transport food all across the country). This sounds like an optimization problem!
  4. Pollan proposes a way to measure how healthy out diets are: the fraction of our meals that we cook ourselves. Discuss amongst yourselves. Looking at the fraction of our diet that comes from plants (as opposed to animals) could also a decent measure or looking at the fraction of our diet that is not made of corn by-products (corn syrup) eaten might be OK. On the other hand, a diet of all Fritos is 100% plant-based so it scores high in my first measure, but it is also 100% corn-based, so it scores low in my second measure. I think Pollan has me beat.

Pollan recommends starting a vegetable garden. Apparently during WWII, Eleanor Roosevelt was instrumental in the Victory Gardening program that encouraged people to start vegetable gardens at home. It is widely reported that at the end of WWII, 40% of the US food production came from these 20 million gardens. This is way better than “Freedom Fries.”

I started a garden this year. I built a raised garden bed and planted tomatoes, zucchini, green beans, eggplant, sweet potatoes, hot banana peppers, and butternut squash with various levels of success. It was easy and fun. Digging up sweet potatoes was more fun than I could have imagined (9 small plants yielded about a bushel of sweet potatoes). My cherry tomatoes were so delicious that I ate all of them right off of the plant (a few a day over the course of several weeks). It didn’t generate 40% of my food consumption, but it’s a good start.

Watch the Michael Pollan interview here.

contaminants in baby formula

As reported a few days ago, the FDA finally set the maximum safe level for melamine and cyanuric acid at 1 part per million each (after resisting setting a safety threshold in October). There is no safe level if both melamine and cyanuric acid are present. I just love the more complicated joint safety threshold. But I am underwhelmed by the FDA’s test results. Just two tests have positive results for melamine (0.137, 0.140 ppm) and three tests have positive results for cyanuric acid (0.247, 0.245, 0.249 ppm). While so many tests have zero melamine, and the ones that tested positive are well below the limit, I’d like to know a little more about the source and distribution of the contamination, since 6 babies died and 300,000 were hospitalized due to melamine contamination in China.

The variance is for these things is important. The FDA issued concerns about tuna after Consumer Reports noted that about 6% of light-tuna samples tested by the FDA had much higher levels of mercury than the other 94% of light-tuna samples. The levels weren’t necessarily dangerous, but high variance = more uncertainty = more risk. I’d like to know that the melamine levels in baby formula has low variance. The fact that so many tests found no melamine is promising, but given that the contaminant is present, shouldn’t some kind of confidence interval be constructed to “prove” that formula is safe?

This whole melamine saga is yet another reason I support breastfeeding. You never know what contaminants are going to be present. Having said that, most women are not able to exclusively breastfeed for the recommended duration of at least one year (10.4% make it to 12 months without having to supplement with formula), so most babies will be getting formula. Mothers shouldn’t have yet another thing to worry about.