More on reforming healthcare

Imagine a new policy  in which all physicians would be expected to perform all medical services. The general practitioner would be truly general. He would be expected not only to see patients in the office and manage common chronic conditions, but to also perform brain surgery, manage high risk pregnancies, do lumbar fusions, manage dialysis, read MRI scans and PET studies, diagnose and treat schizophrenia, do liver and kidney transplants, heart catheterizations and so on. No one assumes that this is practical or desirable. No one practitioner could possibly become proficient at each of the varied diagnostic and therapeutic procedures that make up modern healthcare.

This illustrates a well-known economic principle, and that is that specialization is more efficient than generalizations. It is more efficient, and presumably better for patient to have a heart surgeon perform 160 bypass operations a year, than to have a more broadly-practicing practitioner perform 3 in two years. There clearly is a benefit to separating practitioners into discernible groups, i.e. specialties, to improve the efficiency of healthcare delivery. A corresponding principle also applies to receipt of those services. Tailoring the delivery of services according to some rough, but useful categorization of patients based on relevant characteristics is on the whole more efficient than treating each person as a fungible consumer of healthcare services. There is a rationale to considering the patient with stage IV lung cancer as a qualitatively different consumer of healthcare than a 30 year old with diabetes. Of course such categorization is complicated by the fact that diseases and healthcare needs can occur in combinations and series, and there is no obvious method of constructing categories with distinct boundaries based onlyh on clinical criteria. A rational approach to healthcare reform would find some other means of classification, and this will be addressed in the next entry.