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Those strike me as being pretty big numbers, Livio. Can't help but wonder though if there weren't omitted variables, that skewed the results. OK, they tried to adjust for as much as possible, but there must be things they didn't have data on, or we don't know about, that make healthcare spending look more efficient in some places than it really is.

One of the issues is the analysis of value proposition of health care. As I am unfortunately no longer consuming the option value of the health care but rather an extensive user of its services I can speak from personal experience that some of the efficiency gains have clearly come at the expense of and stress to patient and caregivers. Personal expenses and costs as well as the value of increased stress and time costs for the patient are not sufficiently recognized in these studies.

@Nick: If by big numbers you're referring to the 18-35% potential reduction in preventable deaths, the analysis notes that most of these could be gained through improvements in primary care, population health, and reduction in preventable hospital readmissions. The problem is that, while true, many of these changes depend on voluntary behavioral changes in the patient population rather than process or technical improvements in the healthcare system itself.

I'm not entirely surprised, given that there's some evidence that health care, a field where terrible information quality is standard, is prone to *completely useless* spending and even *counterproductive* spending.

I wouldn't be surprised if the "inefficient" places have policies which are not merely inefficent, but just plain bad -- here in the US, many hospital administrations have set up perverse incentives set up to kick people out of hospital early, even when it means that they need to be readmitted at great expense later.

In short, I'm going to guess that "efficiency" is the wrong way to think about it: provide better health care and your efficiency will probably go up. Try for "efficiency" and your efficiency will probably go down. (As Jciconsult says, "some of the efficiency gains have clearly come at the expense of and stress to patient and caregivers.")

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