Missing Analogies
Alex:
I cannot think of a simpler change that would improve health care to as great an extent as freeing the data.
He was riffing off Newsweek:
In trying to find the oncologist or cancer center with the best track record on, say, stage IV bladder cancer, even the savviest patient quickly hits a wall: with a few exceptions, cancer centers treat these “outcomes” data like state secrets. … For these cancers there are indeed significant outcome differences depending where you are treated. … The Cleveland Clinic is the only one that makes its detailed outcomes data available to the public. … Although the National Comprehensive Cancer Network … collects data on how well its members adhere to treatment guidelines, it will not release the information on specific centers.
Years ago as a health policy postdoc at UC Berkeley, I was stunned to hear a famous health economist explain it was good that the government did not disclose the med outcome data it made hospitals collect – the public might “misinterpret” outcomes, you see, not correcting right for differing patient mixes. He didn’t think it relevant that the same argument suggests Consumer Reports not publish car reliability stats, since they do not correct for driver differences.
Eric Crampton notices a similar mistake:
I’ve about a half dozen times heard … spokespersons … arguing that allowing private competitors into …. the New Zealand Accident Compensation Commission, is bad because private firms have to earn profits and so they’ll have to have higher cost structures than the public insurer. But no National Radio interviewer provided the obvious retort: If the argument were true, we’d want the government to be running everything!
The core problem seems to be that folks who intuitively feel that area A deserves special treatment T look for a justification, and then stop when they find a feature F of area A that suggests treatment T might be a good idea. But by stopping there, they do not consider why this argument does not also justify the same special treatment T of areas B, C, D, etc. that also have feature F. This is an extremely common error, even among folks very skilled at analyzing math models of feature F.
To justify their intuitions that medicine should be treated specially, people often refer to features like sometime large decision consequences, sometimes large prices, suppliers knowing more than customers about product quality, customer behavior influencing customer outcomes, etc. But such folks usually do not favor giving other areas that share these same features the same special treatments.
I agree that access to this data would be a good thing. However, I think your argument dismisses the data misinterpretation problem too quickly.
Here in the UK the media is constantly distorting debates about healthcare and as a result we have had to set up an independent body (NICE) to make comparisons between drugs and hospitals.
Data together with rational debate can leed to good outcomes.
Data, together with an irrational media, that falls for or exploits several cognitive biases (and errors in reasoning) in pursuing a story... doesn't leed to such great outcomes.
Access to information might have a negative effect in the short term and access to this information requires a more developed deliberative process within society.
But the right solution in my view is to have access to this information and provide better education for the public, journalists and better ways of presenting complex information. Independent oversight bodies (private or public) are a good idea too so long as they use a well thought through methodology.
Most procedures and situations are very standardized and statistics could be easily compared and understood by the general public. For example; all hospital induced infections should be public information. The rate of nosocomial infections (hospital created infections) says a lot about the sanitary conditions of the hospital and the quality of it's staff and management.
Things like outcome data for 4X heart bypasses by hospital and surgical teams can also be easily understood. You don't get a bypass unless you need it and you are in real trouble. In fact, I can't think of an area or problem where outcome data would not have been useful.
Even when asking a Dr. about outcome data, I have gotten answers like "very low risk of death" or 85% 2 yr cure rate but no references to journals or government collected statistics to back up those claims.
In a recent case (cardiac ablation), I was forced by lack of solid data to choose a Dr. on the basis of recommendations by reputation among other Dr.'s and the quality and readability of his scientific publications (which has nothing to do with how good his "hands" are).