Healthcare reform and cost containment

Back in May I flagged an article by Atul Gawande. That piece, which put McAllen, Texas on the map (but not in a good way), illustrated nicely the consequences of the perverse incentives built into the fragmented U.S. healthcare system. The article became required reading in the White House during the debate over healthcare reform.

Dr. Gawande has another article in the New Yorker this week, this one addressing strategies for cost containment. Although failure to more aggressively curb costs has been a common criticism of the current reform bills, Gawande argues that pilot programs such as those included in the bill (including one that would penalize hospitals with high infection rates) are the most promising long-term approach to cost containment and quality improvement.

He uses the history of U.S. agricultural practices as an analogy, arguing for a form of positive deviance writ large--establish small-scale pilots around the country, and expand or replicate those that are successful. The process would be guided by government but not with big comprehensive mandates.

I agree with that general approach to quality improvement and infection prevention, and I think we are already seeing how certain interventions that clearly work (e.g. the central-line associated bloodstream infection prevention bundle) are being more widely adopted. What we desperately need is more funding to quickly study competing approaches and determine what works best.


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