Health Affairs highlights

Skimmed through the July/August Health Affairs on my flight last night and found a few provocative things.The Letter from the Editor ponders why US health care spending is so high:

Truth to tell, there is no constituency with any real influence that favors constraining these expenditures.

---Health Spending in the United States and the Rest of the Industrialized World challenges some of the conventional wisdom.

High-technology medical equipment is frequently cited as the main driver of escalating health spending. Although the United States tends to be an earlier adopter of medical technologies, it does not acquire medical technology at high levels once the technology has diffused widely.

Based on 2002 OECD data, the US has a lower penetration of MRI and CT machines per million population than many countries, including Austria, Switzerland and Japan. (Although it’s possible our machines are used more.)There is a higher incidence of medical malpractice claims in the US than Canada, the UK, or Australia but more of those claims are dropped, dismissed, or found in favor of the defendant in the US and the average payout per case is actually lower in the US than in Canada or the UK. Per capita malpractice payouts are barely higher in the US than elsewhere. There are a number of caveats, but still…---Riding The Rollercoaster: The Ups and Downs in Out of Pocket Spending Under the Standard Medicare Drug Benefit

Beneficiaries who experience the biggest gaps in coverage are likely to do so year after year, with potentially serious financial consequences

Under the Medicare Modernization Act insurance carriers are no long able to offer gap coverage for drugs---Access and Quality: Does Rural America Lag Behind? 

Across most dimensions examined, access and quality in rural areas were either equivalent or superior to that provided in urban areas. However, rural residents have greater difficulty obtaining mental health services…

At least that should make Tom Cruise happy