Daily Archives: November 12, 2009

For Bypass Surgery, Off Is Out and On Is In

If you made it past my confusing post title, congratulations. This is just a short piece to acknowledge that a dear friend of mine recently underwent coronary artery bypass graft (CABG) surgery and to wish him well. He’s been in quite a lot of pain, and not resting well, so I’ve not been in direct touch with him, but according to updates from his family, he’s on the mend, which is great news. When he gets back in the groove, I’ll be curious to ask him whether his procedure was done using a heart-lung bypass machine (“on-pump”) or whether he opted for the “off-pump” procedure to avoid some of the anecdotal risks of going on the machine (e.g, stroke, cognitive deficits, and other poor outcomes).

My Papa had bypass surgery years ago and his procedure was done “on-pump.” The doctors had a difficult time getting him back off the machine and starting his heart again, and we suspect that this deprived his brain of oxygen for some period of time, because he seemed to have some cognitive issues (e.g., poor short-term memory) in the immediate wake of the event. From this experience, and stories of others like it, I can understand why people would want to opt for the “off-pump” procedure…..until you realize that that means your surgeon will be attempting to place sutures on a beating heart, which sounds a bit like sipping hot coffee on a roller coaster.

Fortunately, we now have good evidence (from a rigorous randomized control trial) that stopping the heart and using the bypass machine appears to result in better long-term outcomes than the more recently adopted “off-pump” method. The study published in the New England Journal of Medicine, finds that the patients who went on the heart-lung machine did not suffer disproportionately more adverse effects, and actually had better morbidity and mortality outcomes at one year post-operation than the group whose hearts never stopped beating throughout the surgery.

This is a great example that not all innovative practices represent progress, and that such comparative studies are necessary if we expect ongoing improvements in health care quality. I don’t know about you, but if I’m lucky to live long enough to need bypass surgery, I’m glad to be armed with this information, and only wish we had even more of it to turn to.

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Posted by on November 12, 2009 in Uncategorized


Latest Health Wonk Review Is Out

Louise Norris over at the Colorado Health Insurance Insider hosts the most recent edition of Health Wonk Review. Yours truly has two posts featured in this one. Take a look to see what others are saying about health reform and a variety of other topics.

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Posted by on November 12, 2009 in Uncategorized


Health Care Prices Around The World

Starting today and running into the beginning of next week, I’m going to be making some pretty charts that demonstrate just how the U.S. stacks up against its counterparts in the rich, industrialized nations of Australia, Canada, France, Germany, Netherlands, Spain, and the United Kingdom in the area of health care costs.

There won’t be any numbers today. This is just an introduction, albeit an important one. For starters, I should let you know that the figures are based on 2009 data compiled by the International Federation of Health Plans. You can find out more about this organization here.

Countries for which data are included are represented by health care payers and providers who have elected to participate in the federation. This, of course, raises a question about who the participating members are from the United States. The list, you’ll be pleased to know, is none too shabby and includes:

  • Aetna
  • America’s Health Insurance Plans
  • Blue Cross & Blue Shield Association
  • Blue Cross & Blue Shield of Massachusetts
  • Blue Cross & Blue Shield of Wyoming
  • HIP Health Plan of New York
  • Kaiser Foundation Health Plan

I mention that for one simple reason: All of the above entities have no motivation for reporting artificially inflated price data. If anything, they would be better served by reporting that prices are actually lower than they really are. Therefore, when the data, which I will be presenting later, show that health care in the United States is much pricier than it is in other countries around the world, you can trust that those figures aren’t biased.

A word about how I’ll be presenting the data: Each day, I’ll focus on one specific type of health care. First up will be diagnostic imaging, followed by physician fees, hospital charges, total hospital and physician charges for certain services, laboratory tests and cultures, and prescription drug prices. Stay tuned. It should be quite interesting.

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Posted by on November 12, 2009 in Uncategorized

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