McAllen, Texas and the Overuse of Medicine

Atul Gawande is a surgeon at Brigham and Women’s Hospital in Boston and a talented writer.  Last week the New Yorker published an essay of his, The Cost Conundrum, about how McAllen, Texas is the most expensive healthcare market in the US (and probably the world).  Granted people are not very healthy in McAllen.  So, he compared McAllen’s average of $15,000 per person to nearby, and equally unhealthy, El Paso … costs were almost exactly half of McAllen, $7,504 to say nothing of quality or outcomes (for the highest quality outcomes we turn to Mayo Clinic, in our fair state, which costs an average of $6,688).  So, why are costs in McAllen twice what they are elsewhere?  Simply put: overuse of medicine.  Gawande explains that doctors are compensated not on quality of their care rather quantity:

Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.

Apparently, Obama has made this mandatory reading for his staff.  If we could reign in places like McAllen, Medicare could save 30%.

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1 Response to “McAllen, Texas and the Overuse of Medicine”


  1. 1 bobbyjones June 19, 2009 at 8:14 am

    Terry Gross interviewed Dr. Atul Gawande on Wednesday. Listen to the interview here:

    http://www.npr.org/templates/story/story.php?storyId=105483669


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