Cognitive Daily brought my attention to an interesting study about consumers and health care. Simply put, Americans are terrible at knowing when we are getting good medical treatment. Our satisfaction with our doctors bears no relationship to how good our doctors actually are.
This shouldn't be too surprising. Psychologists and economists have long known that humans are bad judges of health and health care. As Amartya Sen pointed out several years ago, life expectancy is often inversely related to self-reports of sickness. Sen arrived at this outlandish conclusion after looking at the health statistics of India. Kerala, the southern most state in India, has the longest life expectancy of any Indian state by a significant margin. But Kerala also has, by a very high margin, the highest rate of people who consider themselves sick. At the other extreme, Indian states with low longevity and woeful medical facilities, such as Bihar, have the lowest rates of self-reported sickness. Why do healthy people consider themselves sicker? Because they are used to a higher standard of well-being, and thus are more sensitive to negative changes in their health. On the other hand, people living in states with terrible public health tend to turn a blind eye to non-fatal illnesses. If it doesn't kill you, then it probably isn't worth complaining about. As Amartya Sen observes, "If we insist on relying on self reported morbidity as the measure, we would have to conclude that the United States is the least healthy in this comparison, followed by Kerala, with ill provided Bihar enjoying the highest level of health, in this charmed internal comparison."
In order to understand why the longer lived Keralans feel less healthy, it helps to look at experiment performed by Daniel Kahneman. Kahneman got the idea for his experiment after realizing that the length of a colonoscopy - a painful medical procedure - had little effect on a patient's self-reports of suffering. In other words, a colonoscopy that lasted 4 minutes was just as bad as a colonoscopy that lasted 1 hour. At first glance, this data makes no sense. A longer colonoscopy equals more pain, right?
Wrong. In his experiment, Kahneman took two separate groups of male patients, and gave both groups a colonoscopy. One group received the standard procedure. The second group received the same treatment, except that at the very end of the procedure the doctors let the instrument sit in place for a few extra seconds.(This is relatively painless.) If humans were rational, the first group would experience less overall pain, since their procedure was a few seconds shorter. Of course, this isn't what happened. The second group reported significantly less discomfort, even though their exam was longer. The reason is that the final moments of their exam involved a relative decrease in the intensity of pain. As Kahneman put it, "What really mattered was the peak pain they had experienced and how much pain they had experienced at the end." Psychologists call this mental habit reference-dependence, and it is built into our nervous systems at a very elemental level. We are designed to detect differences and changes, not absolute values. This is also why Indians who live shorter lives consider themselves healthier. Because they have adjusted to relatively low standards of health, they are relatively insensitive to illness.
So should we be surprised that Americans are satisfied with their health care? Not at all. Numerous studies have reported that most Americans actually get relatively mediocre health care, at least when compared to other developed nations with single-payer systems. Ironically, our satisfaction with our health care may actually be evidence of its inadequacy. Like the Indian citizens of Bihar, we might be satisfied with our medical system simply because we don't expect anything better. We have already gotten used to absurdly high premiums for relatively middling care with high deductibles.
Want to read a truly original solution for our health care crisis? Take a look at this...
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The linked article proposing economic incentives for better healthcare is interesting. One problem is the assumption that institutions like insurance companies behave like rational individuals. Unfortunately, decisions are made by executives pursuing their own selfish interests. An executive planning to retire or move to another company might not worry about the long-term health of people they insure, as long as they don't die on his watch. Similarly, a national health insurance system could work if politicians know voters will turn them out of office if their healthcare deteriorates, but not if they think they can stay in office by banning gay marriage or something.
I am satisfied with my health care for the first time in my life. We live in a small town which is the government center for a sparsley populated county.
If we wish, we can all have team care; our physicians talk to our psychologists who talk to our pharmacists who talk to our specialists. We have a chronic pain clinic available to all who are deemed to be chronic pain sufferers. There are several free clinics for those without insurance or only basic insurance offered by the state; these clinics operate on a donation basis.
I do have medical issues, as does my husband, and we know how very lucky we are!