Monthly Archives: March 2009

Peter Orszag quoted Uwe Reinhardt, the renowned Princeton economist, who asked: “How can it be that the best medical care in the world costs twice as much as the best medical care in the world?” (see “Helping Orszag Get It Right”)

The answer from Mark Pauly, equally renowned Penn economist, is: “Growing the best bananas is in the world in North Dakota would cost twice as much as growing the best bananas in the world in Puerto Rico (both in the US).  It costs more to raise healthy people in hostile climates, like poverty, social dysfunction, racism and low education.”

And Greg Scanlon, of The Heartland Institute, answered by recalling Jack Wennberg’s observation that women in Lewiston, Maine were much more likely than women in nearby Wiscassett to have a hysterectomy. “Of course, the thing Jack didn’t understand is that Lewiston is heavily French Canadian and Catholic, while Wiscassett is almost entirely Protestant. The ladies of Lewiston were using hysterectomies as a form of birth control that was acceptable to the Church. Researchers often ignore cultural differences when making assessments like these. Is it really so awful that, after having six or eight kids, a woman might want to stop without risking eternal damnation?

It’s sometimes complicated to explain why published data are incorrectly interpreted.  This short post and the short paper that it was taken from use Mississippi as a case in point.

Does Mississippi really have more specialists and does it spend more on health care than almost every other state, as Baicker and Chandra claim?  Can Mississippi, which ranks near the bottom in health care quality, lift its status by improving its health care productivity, as their Dartmouth colleagues suggest?  If these questions gnaw at you, as they did at me, there’s a need to probe further.

It turns out that Mississippi doesn’t really have an abundance of specialists.  What Mississippi actually has is a high score in a statistical exercise used by the Dartmouth group. But for Mississippians, it’s not a game. Mississippi has the fewest specialists per capita in the Nation. Mississippians have less and they get less.  

And it turns out that Mississippi doesn’t spend more on health care. As is characteristic of analyses by the Dartmouth group, the metric was Medicare, which is not a proxy for spending overall.  As in many poorer states in the south and southwest, Medicare reimbursement in Mississippi is high, but reimbursement from other sources is low.  It’s no surprise that such states have trouble sustaining better quality.  Less leads to less.

The reality is that health care quality is better where there are more physicians (both generalists and specialists) and where communities make greater investments in health care.  There are limits to how much more Mississippi or the nation as a whole can afford, but be assured — more is more, and that makes the policy choices even harder.