247 - Atul Gawande and the case McAllen, Texas
Autor(s): Romolo M. Dorizzi
Issue: RIMeL - IJLaM, Vol. 5, N. 4, 2009 (MAF Servizi srl ed.)
Page(s): 247-252
The Health reform promised by President Obama has been extensively debated in the recentmonths not only in United States but also allaround the world both in the scientific and professional journals and in general magazines. Oneof the authors present in the two fields is AtulGawande, a young endocrine surgeon and associate director of the Center for Surgery and Public Health at Brigham and Women’s Hospital inBoston, Massachusetts. He is also an associate professor at the Harvard School of Public Health, an associate professor of surgery at HarvardMedical School and director of the World Health Organization’s Global Challenge for Safer Surgical Care. He has written for The New Yorker and Slate pieces on medicine and public health whichhave been collected in his books Complications and Better, published in over one hundred countries. Born to two Indian immigrants, bothdoctors, Gawande grew up in Athens, Ohio. Hewas a Rhodes scholar (earning a P.P.E. degreefrom Balliol College, Oxford in 1989), and latergraduated from Harvard Medical School. He wasa volunteer for 1984 Gary Hart’s campaign andfor Al Gore’s 1988 presidential campaign, servedas Bill Clinton’s health care lieutenant during the1992 campaign and served as senior adviser in the Department of Health and Human Services in the earliest months of Clinton’s administration. His research aims at areas ranging from surgicaltechnique, US military care for the wounded, error in medicine. In a very tantalizing article written for The New Yorker in June 2009 he reportedthe case of McAllen, a 100,000 inhabitants city inthe Southern Texas, which is one of the most expensive health-care markets in the country; in2006, Medicare spent there fifteen thousand dollars per enrollee, almost twice the national average. The author pointed out that cardiovasculardisease, asthma, HIV, infant mortality, cancer, andinjury rates in the Hidalgo county are actuallylower than the national average. Even if El PasoCounty, eight hundred miles up the border withMexico, has essentially the same demographics,Medicare expenditures in 2006 at El Paso were$7,504 per enrollee-half as much as in McAllen.We summarize Gawande’s comments and opi¬nions; an important clue is that differences in decision-making emerged only in some cases. In situations in which the right thing to do was wellestablished, physicians in high-and low-cost are¬as made the same decisions, while in cases in which the science was unclear, some physicianspursued the maximum possible amount of testingand procedures; some pursued the minimum.
Key-words: Atul Gawande, health care costs, Medicare, Mayo Clinic, McAllen.