Atul Gawande answers objections

H/T to DB for pointing me to this follow up article by Atul Gawande concerning his earlier New Yorker piece on health care costs.

Here he elaborates and provides more data in response to objections and questions concerning his original article. He also re-emphasizes that it’s all about organization and leadership and gives another example, Scott and White Hospital in Temple, Texas which is part of an integrated medical group in many ways like Mayo Clinic. Despite having, purportedly, more physicians per capita than any other community in the U.S., Temple Texas has high quality scores and low costs.

One quibble. In answering the point about McAllen’s poverty as a possible driver of utilization he says:

By any measure, McAllen’s poverty and poor health fails to account for its differences from El Paso. St. Louis is located in another county that is just as poor as McAllen (it is the third-poorest county in the U.S.). Its cost per Medicare enrollee? $8,306.

St. Louis is not located in a county. It is an independent city. The surrounding St. Louis County, particularly its western aspect, is very wealthy. This leaves me wondering how well he checked his other “facts.” It is not clear whether his figure of $8,306 per enrollee represents St. Louis or St. Louis County. The demographics and culture are as different as night and day. (I grew up in the area).