The Rise of the Hospitalists
By Amy Willis
If there was a simple health care intervention that could decrease the likelihood of hospitalization, improve your mental health, and cost less, it would a be a no-brainer, right? Well that’s exactly what physician and economist David Meltzer thinks he has uncovered. In this episode, EconTalk host Russ Roberts sits down with Meltzer to discuss the controlled experiment he has been running for several years, as well as the health care industry generally and the relationship between medicine and economics. (Roberts and Meltzer even shared the same thesis adviser, Gary Becker, at the University of Chicago!)
1- What is a “hospitalist,” and why have their ranks increased so significantly, according to Meltzer? What are the advantages of ever more hospitalists? The disadvantages? (Consider this CEE entry on cost-benefit analysis for inspiration…)
2- What do you think are the essential elements of the doctor-patient relationship? What role should electronic medical records play in this relationship?
3- What do the results of Meltzer’s CCP (Continuous Care Physician) study suggest about the efficacy of our health care system? About the division of labor? What do you think Medicare will decide about Meltzer’s proposal for a “physician-focused payment model?”
4- Who has the greatest incentive to push for the sort of model in Meltzer’s study? The least? How might these incentive structures affect the probability of such a model becoming common practice?
5- While Roberts bemoans the continual shifts away from markets in the health care sector, Meltzer retorts with a caution regarding leaping into market-based reforms. Says Meltzer, “there is in my mind not a strong theoretical justification for simple market-oriented interventions in health care without their empirical analysis.” What’s the basis of his skepticism, and what kind of analysis does he think is warranted? To what extent do you find his skepticism justified?