Regional Difference in Procedures and Prices

You might think that once drugs, devices and medical procedures are shown to be effective, they quickly become available. You might also think that those shown not to work as well as alternatives are immediately discarded. Reasonable assumptions both, but you'd be wrong. That's the topic of this week's Healthcare Triage.

John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen – Graphics
Meredith Danko – Social Media

And the housekeeping:

[patrickmulchrone]

I know you all probably don't take requests, but could you talk about ways that health care in rural areas in the U.S. could be improved or initiatives that are attempting to improve it? I think it's an important issue in the light of the new opioid epidemic.

[SkyMurphy]

I think this idea is pretty valid. I've needed a few surgeries. My doctors in my local 40k population town often will tell me "it can't be done", if I go to Stanford or UCSF it can be a completely different story. I've found UCSF much more hesitant than Stanford. Yes, if the surgeon does surgery X every Tuesday and says he's about 80% successful, I"m probably in. I"m seeking doctors/surgeons who have seen cases like me before.

[johncoleman]

This was very interesting I'd like to see another video on this but discussing the issue of people going to different states or countries for medical treatment, and discussing the pros and cons and risk, keep up the good work aron

[hotdrippyglass]

Keep up the good work Doctor Carol. You and the crew are making a difference.

[ethat]

Great topic - regional variations in health care utilization have been consistently demonstrated across countless research studies and countless specialties within health care. Just one footnote, you mentiioned cardiac bypass rates -- you cannot compare bypass surgery rates to decide on differences of cardiac utilization, since the decision on who goes to bypass is unlikely to vary across regions.. In other words, any difference in bypass rates across the nation would likely reflect true regional differences in cardiac disease. However - cardiac stent rates, cardiac imaging rates or total cardiac utilization - would be more relevant markers of regional variation in cardiac utilization as these are more subjective.

[amschmarvelous]

I wonder how much it is also a self feeding loop? You have a back surgery center in an area. It gains some traction. This means you need add a surgeon. You, the current surgeon with beliefs about back surgery, hire someone whose philosophy matches yours. This leads to more surgery.

[InorganicVegan]

Can you talk about lack of price transparency and insane markups in healthcare?

[arillusine]

Thank you for this interesting video, would it be possible to have one discussing the difference between federal coverage like Medicare vs. private insurance companies?

[josephfichtner]

I was thinking about a doctor who got fired for using an out of date testing procedure. Interesting to see this come up moments later.

[kelsey]

Requesting help, I know it's a long shot but here goes: I have been diagnosed with unstable spondylolisthesis on my L1 S5, currently a max shift of 20mm. I have little to no pain right now but under best case scenario my surgeon thinks I will require spinal fusion surgery within 5 years and a 10-15% chance of future degradation if we have the surgery. However, I am not in best case scenario as we want to have a baby. I'm stuck with a choice of doing the surgery now, or baby now and crossing my fingers that I don't end up in major pain during pregnancy and/or needing surgery shortly after a baby is born. The latter seems like a terrible choice to me but I actually don't know what the real stats are. Any suggestions for places to research pregnancy and spondylolisthesis or success/failure rates of spinal fusion surgery for unstable spondylolisthesis would be greatly appreciated.
Thanks!

[greenfire]

Wow my father recently had back surgery for pain and a pinched nerve. I wonder if it was necessary...

[Giatros]

Based on this what should patients do? If a doctor recommends something how can we double check their claim for accuracy and not skewed recommendations?

[bugoid]

So with the Walmart situation, should we really interpret that as a sincere effort by Walmart to provide high quality of care while reducing unnecessary procedures? I feel like if I were a large corporation notorious for scrimping on employee benefits, the best possible way to reduce the number of employees getting spinal care would be to force employees in significant pain or discomfort to cram into cars or planes and travel halfway across the country for care. Am I being too cynical here, or appropriately cynical for Walmart?

[JustinAlexanderBell]

Can you do an episode on the outrageously high costs of dental care?

[JustOneAsbesto]

I went in for a routine hernia operation, and they accidentally removed my Nebraska!!!

[AnnAmbler]

Hmm...that Wal-Mart plan gave me pause. On one side saving what might be needless surgery suffering for patients and saving money vs. the idea that a company could tweak who's in-network for specific expensive operations and coverage. Hmm...