Saturday, June 27, 2009

Fact checking for Atul Gawande

As much as I liked Gawande's New Yorker article I'm having increasing reservations about the accuracy of his assertions, as I suggested here. I think the comment thread from Thursday's post deserves reposting:

Clinton said...
Just some fact-checking.
St. Louis County's Medicare $/beneficiary = 8,306.

Not sure if Wikipedia is a great reference, especially lacking an independent citation, but St. Louis does not show up as #3 (that spot belongs to Starr County, TX.)

Hidalgo County hits the list at #22, while St. Louis doesn't even hit the lowest 100 list. Something isn't quite right with Gawande's statistics. Maybe he is going off of a different set of measures than lowest income per capita or median household income?

http://www.dartmouthatlas.org/interactive_map.shtm
http://en.wikipedia.org/wiki/Lowest-income_counties_in_the_United_States

R. W. Donnell said...
Clinton,
The figure you cite is identical to his. That's for St. Louis County, as he said. The problem is, St. Louis County is not among the poorest regions in the nation by any metric or any stretch of the imagination. The City of St. Louis (which is, I repeat, NOT in St. Louis County) may be. He doesn't seem to have any idea of what the cost per enrollee is for the City of St. Louis, but that's what he needs to cite if he wants to make his point about poverty and Medicare expenses.

My guess would be that the cost would be high in the City of St Louis. I think care is pretty fragmented and under served. Most of the hospitals (aside from ones affiliated with the two med schools) have moved to the burbs, so the picture there is pretty atypical.

I don't consider Wikipedia a very authoritative source but I know St. Louis is a city without a county from personal familiarity with the area.

Raises even more questions about his fact checking.

4 comments:

T Scott said...

I wonder if Gawande didn't mean to refer to EAST St. Louis, a very poor city on the Illinois side of the Mississippi.

R. W. Donnell said...

Who knows. He's either being sloppy with his terminology or is confused about the geography and demographics of the area.

Clinton said...

I just looked at the Darthmouth map and hovered over what was reported at St. Louis County for confirm his medicare number.

I couldn't find any figures that backed up his allegations about St. Louis being a poor county though. The wikipedia reference was the easiest at hand. Glad that you could clarify the differences a bit more... I'm totally not familiar with the cities and counties of the midwest.

R. W. Donnell said...

I am very familiar with St. Louis County and it is not poor by any stretch of the imagination.