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Hot Spotting Medical Care

by Elaine Schwartz    •    Jan 28, 2011

These are the statistics: 900 people; 4,000 hospital visits; $200 million in medical bills from January 2002 through June 2008. The place is Camden, N.J. where a relatively small number of people were responsible for a huge proportion of the city’s medical expenses. 

The problem then, is to figure out how to control their needs. Surgeon and New Yorker Magazine staff writer Atul Gawande gives us some answers in “The Hot Spotters.”

Inspiring, discouraging, and fascinating, the article focuses on 3 case studies. In Camden, the solution was one physician who statistically identified medical “hot spots.” Next, using a patient-by-patient focus with a team of doctors, nurses, and social workers, specific problems were targeted with coordinated care. Health improved, hospital visits diminished, costs dropped. It worked.

The other 2 stories illustrated different approaches in different places but they, too, had success. The common denominator was statistical and human understanding of the high cost patient with many ailments.

In a follow-up blog comment, Dr. Gawande characterized several responses to the national implications of his article as “defeatist, catastrophist, or triumphalist.” You might enjoy reading the exchange. 

The Economic Lesson

Sometimes, the law of demand can backfire. Occasionally, we do not want people to decrease quantity demanded when price goes up.

In “Hot Spotting,” Dr. Gawande tells us about a firm that tried unsuccessfully to cut medical costs by increasing the co-pay for each medical exam. More “skin-in-the-game” was supposed to eliminate unnecessary doctor visits. Some recipients, though, eliminated necessary doctor visits and necessary prescriptions. As a result, they wound up with expensive emergency room care and chronic illness. 

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