tag:blogger.com,1999:blog-3829599.post9070305702441634168..comments2024-01-28T00:20:40.933-08:00Comments on Agoraphilia: Explaining the RAND ExperimentUnknownnoreply@blogger.comBlogger3125tag:blogger.com,1999:blog-3829599.post-66685434704301299012008-07-13T09:23:00.000-07:002008-07-13T09:23:00.000-07:00The folks who conducted the RAND study concluded t...The folks who conducted the RAND study concluded that the group receiving more medical care did not just get more useless medicine; they also got more health-productive medicine, but the benefits were offset by additional harmful medicine.<BR/><BR/>There were many groups in the experiment. There was the group that had 100% coverage, or "free" care. There were groups that faced cost-sharing of 25/50/75/95 percent up to a high deductible. There was also an HMO group enrolled in Group Health in Seattle. Outcomes for all six groups were similar. (The HMO group also spent much less than the "free" group. Thus an interesting implication is that HMOs do as good a job of eliminating unnecessary services as high-deductible insurance.)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3829599.post-7692069163861997732008-01-05T11:30:00.000-08:002008-01-05T11:30:00.000-08:00I have to agree with the counterintuitivity of the...I have to agree with the counterintuitivity of the majority of health surveys and experiments. The three concepts that you wrote about are what I've noticed over the years of cringing while reading health studies. My thoughts:<BR/><BR/>1. Additional health services can and do indeed produce undesirable consequences. Diseases that are contacted at the hospital are called "nosocomial infections." These are viral and bacterial. The reason we acquire these so frequently is that when we are hospitalized we are usually under an undue amount of stress--psychologically and physically, which most definitely lowers our immune system. If we are ill due to an infection in the first place, our immunity is challenged on a more frequent basis. Put these factors together along with gender, age, and even race and you're pretty much a walking disease time-bomb. People who receive health care due to a trauma, let's say an open head injury, are less susceptible to nosocomial infections due to the fact that they are usually (not always) on the younger side and are able to fight infections more effectively. The fact that most head injuries lead to either doctor-induced or naturally induced comas (which protects the brain while it tries to heal itself) would rule out the natural psychological lowering of the immune system due to stress. My personal belief is that there are too many variables with health care, especially hospitalizations, for any type of conclusive study-- especially when it comes to insurance. Is insurance coverage a major consideration in hospitalizations? ABSOLUTELY! Insurance coverage is a psychological stress for a huge number of people. How can we possibly do an "experiment" or "study" with all these variables?<BR/><BR/>2. Two different groups is a ridiculous indicator of any study. Just my opinion. Take it or leave it. There are too many variables within each group. How can a + b = c in a study like this? Another thing--society would love to "group" us to determine how we can fight diseases, economic challenges, etc. We need a little of both grouping and looking at individuals in particular in order get a balance. How can this happen in an experiment like this? I'm not sure if these things were taken into consideration when the groups were put together as I'm not one of the "powers that be."<BR/><BR/>3. All health outcomes are varied due to all sorts of reasons. What would work for Patient A may not work for Patient B. We obviously all have different DNA (with the exception of identical twins,)therefore different chemical make-ups.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3829599.post-72723866976579171842007-12-22T13:24:00.000-08:002007-12-22T13:24:00.000-08:00The great increases in the average lifespan in the...The great increases in the average lifespan in the last hundred year can be attributed to better sanitation, the advent of antibiotics, & the widespread availability of nutritious foods. Maybe vitamin enrichment of foods has something to do with it as well. The heyday for most of those things is past. Germs mutate to make antibiotics ineffective, sped up greatly by doctor's overprescription of them. The world is evermore polluted due to human activity, making food, water & air more vulnerable to contamination. What goes up, like lifespan, may start to come down, if it hasn't already.<BR/><BR/>I agree that stays in hospitals entail hidden risks for sickness from pathogens. But the risk is there from the start of your hospital stay. It may be worse at the start because you are admitted very sick and your body hasn't had enough time to adapt to a new and foreign environment. This should be possible to verify empirically.Anonymousnoreply@blogger.com