Arnold Kling  

Comparing Effectiveness of Health Care Procedures

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Gail R. Wilensky proposes creating a research center devoted to comparing the effectiveness of medical procedures.


The most obvious and direct way to finance at least the public portion of a comparative effectiveness center is through a direct appropriation by Congress. The rationale for public funding is that information is a public good, in the most classic sense: that is, it is not excludable and nonrival in its consumption. Economic theory argues that goods or services that meet this definition will be underproduced by the private sector and should therefore be financed by government.

...it might be possible to rely on the Medicare Trust Funds to finance a portion of the costs, since Medicare would obviously be an important beneficiary and could allow decision making about reimbursement that could result in future Medicare savings.


This is similar to one of the ideas in Crisis of Abundance. Thanks to Michael Cannon at Cato for emailing me the pointer.


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COMMENTS (4 to date)
zach writes:

It'll never happen. Way too many variables to control for. I am a doctor, and even things as 'routine' as a lap chole or a hernia repair or a revascularization procedure have so many variables that each patient is unique in the benefit that they may received from the procedure and what the procedure will entail for them and the complications they may face. While it's a noble idea, humans don't lend themselves to being analyzed in the same way you analyze cars coming off the assembly line. Spend a day working with real patients with real problems and this will become abundantly clear.

zach writes:

It'll never happen. Way too many variables to control for. I am a doctor, and even things as 'routine' as a lap chole or a hernia repair or a revascularization procedure have so many variables that each patient is unique in the benefit that they may received from the procedure and what the procedure will entail for them and the complications they may face. While it's a noble idea, humans don't lend themselves to being analyzed in the same way you analyze cars coming off the assembly line. Spend a day working with real patients with real problems and this will become abundantly clear.

PJens writes:

Zach may have a point. Possibly a better avenue to investigate is the effectiveness of drugs. My pharmasist tells me that over the counter Benadryl is more effective than the perscription alternatives. I have heard before calls for some agency to determine the efficacy rating of drugs. Yet again, a good idea not acted upon?

Bruce G Charlton writes:

This already happens, supposedly, in the UK - with truly massive govt funding going to the Cochrane Collaboration and other types of self-styled Evidence Based Medicine, and various govt agencies such a NICE which rations drugs.

IMO the main effect is to make the UK NHS even more of a soviet-style technocratic provider than it already was.

Furthermore, the results of these evaluations are easy to manipulate, by choice of variables and statistical methods. It is especially easy to show 'no significant benefit' and delay or restrict access to new treatments. In the end the biggest and most powerful bureacracies impose their will on individual consumers - the old story.

All the problems of the FDA multiplied manyfold.

Health care evaluation is the opposite of a libertarian solution when it encompasses almost the whole health care system.

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