In short, he examined McAllen, TX -- one of the most expensive health care markets in the U.S. In 2006, the last year for which data are available, Medicare spent $14,946 per enrollee in McAllen and $7,504 in ElPaso, TX. By comparison, Hartford is $8,241 and New Haven $9,713. U.S. data here.
Gawande examined two approaches to health care payment structures for physicians -- the entrepreneurial -- do more, raise your income model and the team model -- in which physicians are salaried, so there is no financial reward for more procedures. In the team model, in different parts of the country, quality is better and costs are less.
We are witnessing a battle for the soul of American medicine...we pay doctors for quantity, not quality...we also pay them as individuals rather than as members of a team working together for their patients.
Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets at three times the cost you expected?No wonder GI docs laugh about "scoping for dollars."