How much has changed in the past 10 years? Gawande concluded that the high cost of health care in McAllen was the result of a culture of over-utilization in a fee-for-service system among healthcare providers. Compared to El Paso, Gawande discovered that Medicare patients in McAllen received 40 percent more surgeries and two to three times as many pacemakers, cardiac bypass operations, carotid endarterectomies and coronary stents. Per-capita spending on home-health services was five times higher than in El Paso. Yet there was nothing to indicate that patients in McAllen were sicker or received more expensive services than Medicare recipients across the country—they just received more services.

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The author tries to find the answer to this puzzle and draws some interesting conclusions. Firstly, it is not a poverty rate which induces high medical costs in the region.

Even though the per capita income is small, the population does not suffer from the above average number of obesity cases, cardiovascular diseases and frequent evidence of alcoholism. Secondly, the reason is not in the higher expenditures on better technologies and medical equipment there are states and towns when they are considerably better and more sophisticated.

As it appeared, the answer is in wasted resources. According to the author, these are predominantly inefficiencies which cause such high level of healthcare costs. Since the number of medical tests has increased over time due to the technological progress , physicians gained more opportunities to profiteer from their patients.

As it is written in the text, pay is for quantity not for quality, given that the studies showed that the higher the spendings the lower the quality of the healthcare.

The latter questions their ethics and opportunity for bribes. Works Cited Atul Gawande. The Cost of Conundrum. The New Yorker, June, 1, Yourlastname PAGE ….


Ten years after “The Cost Conundrum” – How much has changed?

Save Story Save this story for later. Analysis of Medicare data by the Dartmouth Atlas project shows the difference is due to marked differences in the amount of care ordered for patients—patients in McAllen receive vastly more diagnostic tests, hospital admissions, operations, specialist visits, and home nursing care than in El Paso. But quality of care in McAllen is not appreciably better, and by some measures, it is worse. Indeed, studies have shown that the care for patients in the highest-cost regions of the country tends to go this way—with more high-cost care across the board, but less low-cost preventive services and primary care, and equal or worse survival, functional ability, and satisfaction with care.


Atul Gawande: The Cost Conundrum Redux

Atul Gawande had been selected to serve as CEO of their joint healthcare enterprise, focus is now shifting to his plans on containing high medical costs. Anyone looking for clues on how Gawande might approach his new job has plenty of material to pull from. His journalistic work has been impressing powerful business people and policymakers for years. The article caught the attention of the White House and was required reading for staffers during weeks of debate on the landmark legislation. The expenditures were also more than triple what Medicare had spent on McAllen enrollees in , which was in line with the national average. Gawande approaches the issue from a national perspective, arguing that if expensive healthcare markets can bend the cost curve to that of low-cost areas, then the larger problems facing Medicare can be solved. Unless we figure it out, health reform will fail.


4 Insights from Atul Gawande's Influential 'Cost Conundrum' Article

Americans like to believe that, with most things, more is better. The summer of was a heady time for health care reform in the United States. The newly elected President Barack Obama was eager to make good on his campaign promises for national reform. And only one month before this article was published, the US Senate Finance Committee held hearings on Health care reform. For this piece Gawande spoke to a small group of doctors whom all practiced medicine in the small town of McAllen, Texas. Why McAllen?

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