Can generosity go too far?

By Julian Baggini
The New Statesman
Originally published on August 21, 2015

Here is an excerpt:

We have heard so many stories of misguided projects and misspent money over the years that surely the time has come to demand evidence that the charities we ­support are effective. But how do you measure whether a charity is effective? One answer would be to apply two tests: does it achieve its stated goal and does it do so as cost-efficiently as it can? A charity such as Guide Dogs might pass this test. But for effective altruists, in deciding whether to give to Guide Dogs, you ought to ask another question: could you get more altruistic bang for your buck by giving to something completely different instead?

They say you can. Guide Dogs UK says it costs £32,400 to train a guide dog and its owner and then another £12,800 “to support the working partnership”. In contrast, Singer says you can save someone from going blind in the developing world for between $20 and $100. “If you do the maths,” he writes, “you will see that the choice we face is to provide one person with a guide dog or prevent anywhere between 400 and 2,000 cases of blindness.”

The entire article is here.

Cost of Treatment May Influence Doctors

By Andrew Pollack
The New York Times
Originally published April 17, 2014

Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.

The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent.

The entire article is here.

A Health Provider Strives to Keep Hospital Beds Empty

By Annie Lowrey
The New York Times
Originally published April 23, 2013

On a stormy evening this spring, nurses at Dr. Gary Stuck’s family practice were on the phone with patients with heart ailments, asking them not to shovel snow. The idea was to keep them out of the hospital, and that effort — combined with dozens more like it — is starting to make a difference: across the city, doctors are providing less, but not worse, health care.

For most health care providers, that would be cause for alarm. But not for Advocate Health Care, based in Oak Brook, Ill., a pioneer in an approach known as “accountable care” that offers financial incentives for doctors and hospitals to cut costs rather than funnel patients through an ever-greater volume of costly medical services. Under the agreement, hospital admissions are down 6 percent. Days spent in the hospital are down nearly 9 percent. The average length of a stay has declined, and many other measures show doctors providing less care, too.

This approach is one small part of a growing effort by providers to hold down costs without restricting needed care. Nationwide, health care spending has grown over the last three years at the slowest rate since the federal government started keeping data more than 50 years ago. While the bulk of that is related to the poor economy, changes among insurers and health care providers have contributed as well. If the trend continues, even at a reduced pace, it could help alleviate Washington’s long-term deficit problems and ease the strain on family budgets.

The entire story is here.

Is A Competitive Health Care Model All It’s Cracked Up To Be?

By Julie Appleby and Marilyn Werber Serafini
Kaiser Health News, in conjunction with The Atlantic
Originally published on September 20, 2012

Republican vice presidential nominee Paul Ryan says his proposal to overhaul Medicare would use market competition to tame costs in the government health program relied on by almost 50 million people.

As models, he often cites the health program for federal employees – including members of Congress -- and Medicare’s prescription drug program. "It works with federal employees, it works with the prescription drug benefit, and more to the point, it saves Medicare," Ryan said on "Meet the Press" in April.

Both of those programs get high marks from beneficiaries for the choices they offer. But their track record on cost control is more complicated, raising questions about whether the competitive model is in fact the silver bullet that backers have suggested. 

The federal employee health insurance program is often touted as holding down the increase in premium prices more successfully than private workplace plans or government-run programs. But a data analysis done for Kaiser Health News (KHN) and interviews with experts shows it has not held down costs per enrollee as efficiently as Medicare during the past decade.

Average spending in the federal workers’ program grew at 7.1 percent annually per enrollee, higher than the 5.8 percent growth rate for traditional Medicare – excluding the drug program -- over the decade ending in 2010, according to data analyzed at KHN’s request.  The analysis, based on 10-year averages, was done by Walton Francis, a consultant and principal author for 30 years of the Consumers’ Checkbook Guide to Health Plans for Federal Employees.

The entire story is here.