How Health Care is Politicized

You may or may not have heard that Texas scored last on Obama’s Health and Human Services’ latest report on healthcare by state.  Of course, like any ranking, it really comes down to what you are measuring.  So what does the study measure?

Summary measures of quality of care and States’ performances relative to all States and the region by:

  • Overall health care quality
  • Types of care (preventive, acute, and chronic)
  • Settings of care (hospitals, ambulatory care, nursing home, and home health)
  • Five clinical conditions (cancer, diabetes, heart disease, maternal and child health, and respiratory diseases)
  • Special focus areas on diabetes, asthma, Healthy People 2020, clinical preventive services, disparities, payer, and variation over time

Notice that the outcomes of the care isn’t mentioned.  In fact, it seems to be weighted very, very low.  This study essentially measures how much time people spend in doctor’s offices and hospitals, and how much money they spend.

In fact, in many of the subject studied, such as diabetes and preventative care, outcomes aren’t even measured.

Texas is scored average for cancer care.  But what do we have in the Above-Average category?  “All cancer deaths.”  “Prostate cancer deaths.”  “Lung Cancer deaths.”  In fact, in all the outcome based measurements, Texas scores above average.  What drags down the score?  Not performing as much breast cancer surgery.  Not doing as many Pap tests and colonoscopies.  Well, if are are doing much less of this and still getting better results, what does that tells us about those procedures?  It seems to me that they don’t have much effect on outcomes.  At the end of the day, Texas is average to above-average on cancer deaths.  The end.

On diabetes, Texas is scored poorly, mainly on admissions to the hospital for diabetes and related complications.   No place in the diabetes section does it appear that there is any measure of outcomes.  Heart disease is a similar story to cancer — Texas does poorly on bypass, CHF and angiopathy deaths, but is average on other outcomes based results.  Prenatal care is scored highly, but one of the complaints is about first trimester care.  If everything else does well, doesn’t that suggest that first trimester care isn’t terribly important?

On respiratory diseases, Texas is average on pneumonia deaths, which is the only outcome based measurement I see.  In this system, however, being average on outcomes only gets you to “weak”, if you aren’t running around immunizing everyone you see.

Overall, this study measures one thing — how often do you go to the doctor, and how much time do you spend in the hospital.  In other words, how much money are you spending on doctors.  HHS has released this study for one reason — to be propaganda for more government spending on healthcare.  I suspect that the measurements were massaged to get Texas to rate low simply because we led the pushback on Obama’s takeover of the state agencies.

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