This Vet Learning About Healthcare Globalization

Published September 8, 2011 by glaumland

This is another journal entry from my class on Healthcare Organizations. Just when I though the healthcare industry couldn’t get any bigger or scarier, we looked at it on a global level. We also looked at longevity that week, but I’ll save that for another post. Wow!


Wow! There is a lot of stuff to think about this week. I hardly know where to start. But I think
I’ll start with the articles.

 “How Health Insurance Design Affects Access To Care And Costs By Income In Eleven
Countries” by C. Shoen et al. – I found this a very interesting article,
but probably not for the reason the authors intended. What I found interesting
was the efforts to make ‘science’ out of opinion. It’s really quite easy, and
lots of ‘scientists’ do it all the time.

 Here’s how it works…you ask people how they feel about a subject and then use their
response to come up with statistics (confusing subjective and objective
information). The authors of this study did exactly that. To establish incomes,
respondents were told their country’s median income then asked if they felt
they were about average, much or somewhat above average, or  much or somewhat below average.  In other words, how do you feel about your income compared to the average? The biggest problem with this methodology is that it can introduce bias issues into your study, and although the authors
admit this problem when it comes to estimating medical expenses, they don’t
mention it about income. Ideally, the authors would have given an exact range
(if the median income was $35K, then ask if people make $30-40K (about
average), $15-30K (somewhat below average), $40-70K (somewhat above average),
etc.) That is a number most people have a pretty good idea about and can answer
truthfully, giving better data. (And about the truthful answer part, another
way to introduce bias is when the respondent either answers untruthfully
because they don’t think it is your business what their income is – I’ve done
that before – or they reply with what they think the correct answer is trying
to please the questioner.)

 Anytime you ask people about their ‘experiences’ you are introducing the potential for more
bias in your study. I can say this from personal experience. If a survey was to
catch me during a bad time with one of my health issues, my responses may
revolve around that one episode and not necessarily take all circumstances into
account. When I’m grumpy and hurting, I’m not necessarily the font of wisdom.
Likewise, asking a patient if they are confident they could get ‘the most
effective’ treatment, how are they to know? Is this their opinion or have they
educated themselves to know the different options and what will work for them?
Also, are they speaking of their own experiences or are they considering those
of friends and relatives in their answer?

 There were a couple of other things I didn’t like about this article. First, they really stressed
that low-income people are more likely to suffer more chronic conditions and be
elderly. Whereas I believe that it is the elderly and those with more chronic
conditions who are more likely to have lower incomes. I think that dollars
earned by the elderly during their working years are not worth as much during
their retirement years, thus many of them fall into the low income category.
This is especially true during this economic downturn when nearly everyone’s
financial worth has taken a hit. I also believe that people with chronic
conditions are less able to have an active or productive work-life (this would
include me) and that is why many have low incomes. It comes down to the
‘chicken or egg’ argument, but I don’t believe that having a low income leads
you to be elderly or sickly; that isn’t logical.

 Another statement in this article was that the countries varied in their ability to provide access
to 24 hour healthcare outside of the emergency room. My first reaction was
“so?” Isn’t that the reason for emergency rooms? I don’t see why this
topic was presented as an ‘oh my gosh’ one. It just seems like a no-brainer to

 That’s true of many of their arguments. Maybe I’m naïve (some of my friends tell me that!) or
narrow-minded (some different friends tell me that!) so perhaps I’m just not
open to these studies that push the benefits of healthcare reform. Although I
have to say I didn’t know that was the purpose of the study when I started
reading it. But by the time I started going through their survey results, I had
a pretty good idea what their conclusions would be. I do know I am suspicious –
it comes with age and experience.

 I know that surveys are difficult to do (and especially in different languages and cultures); it
takes a lot of work and careful consideration to do a survey properly. Adding
in a potential for a lot of bias, then covering it with statistics, just leads to
the creation of junk science, and that’s what I think they have here. I can
honestly say I was not as impressed with this report as with the other articles
we read this week where ‘real’ numbers were used. And there I’m exposing my
bias against healthcare reform, as I don’t believe one bill can effectively or
efficiently cure all issues. I think there are some ways in which really good
studies could have been designed (like retrospectively looking at
post-hospitalization surveys). I do agree that you will miss some important
sections of society and some important information, but again, I don’t think
you can design one study to get all answers.


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