Article Review

American Surgeon and Writer Atul Gawande on his New Yorker articles “The Cost Conundrum”

and “The Cost Conundrum: Redux” reviews the state of health care in McAllen, Texas. He puts

forward that in 2009 the state of health care of the district was poor. The district practiced

evasive surgeries, did inefficient scientific tests, high rates of hospital admissions, and pathetic

outpatient home health care. Besides, McAllen had the most expensive health care system in the

United States (US). The district spent twice on Medicare compared to other states ($14000

against $7000). However, visiting the district after some time, he found a modified state of health

care. The number of inpatient visits had fallen by one-tenth; both home health care cost and

ambulance rides were down by forty percent, and the charges for Medicare dropped by $3000;

thus, half a billion dollars was saved.

Several stipulations caused these changes in McAllen’s health care. First, the physicians obtained

data from Arkansas's Payment Improvement Initiative that enabled them to compare their

performance and quality scores with their peers in other States. Once the physicians identified

that their costs were high, they called the organization to enquire about how they could lower the

costs. Second, doctors administered by the book medicine since the clinical leadership had

abolished the reimbursement systems that limited the doctors' niche. Also, the doctors provided

heightened educational services on the overall health to patients instead of the symptom- service-

treatment -practice cycle.

Third, adoption of the ACO- like group alternative payment model that enabled the physicians

to share in the savings aided control the health care costs. Consequently, the clinic leaders who

adopted the new model were more productive and rendered quality health care. For conditions
like diabetes, which consume a lot of money to be managed, innovations have helped reduce

these costs.

Summary

Demographic differences between McAllen and El Paso were on age distributions. Persons who

are younger than 25 years, McAllen had 37% while El Paso had 36%. For Ages 25-49, McAllen

had 44% compared to El Paso’s 39%. For cohort 50-65, McAllen was at 19% as El Paso had

26%. In both regions, only a small percentage of the population is over 65 years.

The doctors administered medicine by -the- book. Also, they provided heightened educational

services on the overall health to patients instead of the symptom -service -treatment practice

cycle. The clinical leadership had abolished the reimbursement systems that limited the doctors’

niche and adopted the ACO- like group alternative payment model that enabled their clinics to

render quality health services. The activities of the doctors can be characterized as ethical as the

health care of the district improved while that of the hospital leaders as entrepreneurial as they

developed the health care of the community and their economic status improved.

The author stated Mayo Clinic had similar better quality and technological infrastructure than

McAllen and produced quality health care at $8000 less than McAllen. The fact that McAllen is

being compared with the Mayo Clinic shows its improvement.