December 25, 2011

Irracionalitat rellevant

La lectura del blog de Forbes m'ha posat la pista d'un article de JAMA. El resum que en fa ho diu tot:

So what do patients really want from health care, anyway?  In a recent issue of JAMA, Dr. Allan Detsky, an internist and health policy expert at the University of Toronto tackled this question, based on his years of clinical and research experience.  It’s a terrific, and sobering, piece, as highlighted below.
Highest priority:
  • Restoring health when ill – “the majority of patients focus on relieving illness and symptoms rather than disease prevention”
  • Timeliness – care is wanted “immediately”
  • Kindness – “in the days before health insurance, patients paid for care that consisted primarily of kindness”
  • Hope and certainty – even in dire situations, patients “want to have hope and be offered options that might help”
  • Continuity, choice, coordination – care from “same person or team” important
  • Private room – including “their own bathroom and no roommate”
  • No out-of-pocket costs – “patients want to pay as little as possible” themselves and to know that “insurance or third-party coverage is always available to them”
  • The best medicine – patients want to know their doctors are “highly qualified” but do not want this information “to be statistical.  They prefer testimonials from other patients or clinicians they trust”
  • Medications and surgery – treatments that patients “perceive will require little effort” are strongly preferred, as are “medications and surgical procedures” compared to “clinical strategies that involve behavior changes.”
Lower priority:
  • Efficiency – patients only modestly interested in care that delivers “the most value with the least resources”
  • Aggregate-level statistics – far less important to patients than treatments are likely to work “in their specific case.”  Also, as before, “testimonials trump scientific evidence.”
  • Equity – patients are more concerned with whether “they are receiving adequate health care services” than whether “all members of society should have a right to it, regardless of income”
  • Conflicts of interest – patients are less concerned about motivation of provider in prescribing particular treatments “as long as the service helps make them better without increasing the costs they have to bear”
Lowest priority:
  • Real costs – “individual patients have virtually no interest in costs they do not bear”
  • Percent GNP devoted to healthcare – “just a number and has absolutely no relevance for individual patients”
Detsky comments, “Some might say that the consumers’ preferences described in this article are irrational and unrealistic; that may be true…. However, the lack of rationality does not render these preferences irrelevant.”

Josep Maria de Sagarra, escrivint La ruta blava.