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Saturday, December 17, 2011

Study Demonstrates That Under-insured (Sometimes) Receive Better Care

The take-away:  uninsured children receive more appropriate antibiotic prescriptions than those with private  insurance.  For those red staters who fear that the "less is more" argument proffered by healthcare gurus is a cover for "socialistic healthcare rationing" in an imagined Obama-Berwick dystopia, here is something to think about...

In the December issue of the journal PEDIATRICS, Adam Hirsch and colleagues report that privately insured patients are significantly more likely to receive antimicrobial treatment when none is indicated, and also more likely to receive broad-spectrum agents when the selection of narrow-spectrum antibiotics (or symptomatic treatment alone) conforms more closely to evidence-based guidelines.

Additionally, patients with the lowest co-payments for their prescriptions were most likely to receive inappropriate therapy.  Not only do these "overuse" errors generate waste in the system, but they also drive antibiotic resistance patterns in the community, and expose children to avoidable complications, such as drug allergy and antibiotic-associated diarrheal disease including that caused by Clostridium difficile.

It would be over-reaching to infer from all this that under-insured patients receive better healthcare overall: there are more than enough data to demonstrate the reverse.  However,  this "man bites dog" story of care disparities does serve to remind us that we have enormous opportunities to improve care by "doing less."

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