Changing Guidelines vs. Changing Practice

It's been a few weeks since an expert panel recommended that the guideline for mammography use be pushed back to age 50 (from age 40). During these few weeks, it was interesting to see how much controversy this understandably generated. As too much screening causes more harm than good, and the panel has demonstrated that this is the case for women in their 40s, physicians and patients alike have opposed the new recommendation and will continue to follow the old recommendation knowing that it only benefits 1 out of 1,900 women in their 40s. I think it's interesting and right in line with our discussion earlier this year on how people react to change. Of course, guidelines are just that, and they likely won't change physician practice in the short run since screenings are administered on many factors such as family history, etc. What about the long run, though?

Health Care vs. Environment/Behavior

This op-ed column in the NYTimes brings up the question of how much of a given disease's burden is attributable to health care vs. behavior. http://www.nytimes.com/2009/12/06/opinion/06kristof.html?_r=2 There's nothing particularly profound about it, but it's a good example of how the public grapples with what we have studied to be the 10%-40% breakdown (10% due to health care, 40% due to lifestyle).

Penny-wise, Pound-foolish

Here is an article about the 10% cut to Medicare-funded home health services proposed in the health reform bills.

http://www.nytimes.com/2009/12/05/health/policy/05home.html?_r=1&ref=health

The NYtimes has done a "close-up" piece on the effects this would have on a home care agency in eastern Maine that is already in the red, complete with a slideshow of the patients they treat.

Though home health services save a lot of money in the long-term by keeping people at home instead of at nursing homes and hospitals, Democrats have proposed these deep cuts to these services because there is "waste and inefficiency" in the delivery system. They hope that the cuts will encourage home health agencies to make improvements, thus strengthening the program. The Republicans proposed an amendment to stop these cuts, and it was defeated by the Democrats.

I do not think that a sudden 10% cut in payments is a good way to spur innovation and improvement - it seems much more likely that it will simply put home health agencies out of business.

Of course, cuts will have to made from existing government programs to pay for health reform, but it is disappointing to see them come from such beneficial services.