Preventive Care

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Taiwan’s National Health Insurance System: Part II

October 3, 2011 in International Health Care Systems | No comments

A recent Health Economics article by Hsiou and Pylypchuk (2011) examines differences in preventive care and hospitalization use between the United States and Taiwan.  The authors find the following:

“The rate of preventive care use is much higher in the USA than in Taiwan, whereas the use of hospital and emergency care is about the same. Results of our decomposition analysis suggest that higher levels of education and income, along with inferior health status in the USA, are significant factors, each explaining between 7% and 15% of the gap in preventive care use.”

Today I review some additional information about the Taiwanese health care system.  This information adds to my earlier review.

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Sigmoidoscopy: The colonoscopy’s cheaper, equally effective predecessor

August 23, 2010 in Physician Compensation, Prevention, Specialists | 1 comment

Physicians claims that colonoscopies are the gold standard of preventive medicine.  In 2008 the American Cancer Society deemed the colonoscopy as the preferred test and the health reform law (PPACA) will compel insurance companies to cover colonoscopies.  But does the sigmoidoscopy–the colonoscopy’s predecessor–offer less expensive, less invasive, equally effective preventive care?

“[The sigmoidoscopy] looks at only half the colon. In that test, there’s no sedation, no day off from work, no jug of laxatives the night before and maybe no gastroenterologist. Your primary care doctor could probably do the procedure himself…

Colonoscopy is three to four times more expensive than the simpler sigmoidoscopy test. And the risk of complication is seven times higher. Still the idea caught on. And as it did, it transformed the profession of gastroenterology. We went from too many specialists to a national shortage.”

In fact, the inventor of the colonoscopy, Al Neugut, wrote an editorial in the JAMA this summer stating that he regrets inventing the colonoscopy.  On Marketplace, Neugut said “If today, we were where we were in 1988, I would not institute colonoscopy based on the current evidence.”

The gold standard of preventive medicine may only be golden from the point of view of physician salaries.

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