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03/13/17

The Toddler Mind

In the spirit of accelerating our collective learning, I have a suggestion.  Require that all economic research be done using only toddlers as the subjects of the study.  Unlike infants, toddlers are old enough to know a bit about how the game is played, but unlike adults they have not yet been around long enough to learn much social etiquette.  Opinions come blurting out without a filter.

For example, if you say to a toddler, ‘Do you want to go get ice cream or get a puppy?’ you know the answer will be, ‘BOTH!’

There you go – a simple, straightforward study in the human condition and it did not even require a grant from some foundation and a snooty PhD doing regression analysis to find the conclusion.  

See? We can speed this social science thing up a lot.

But, we do still have PhDs to feed, so for now we’ll still do our research the slow, expensive way.  But the findings are often the same as from the toddler test.

For example, some of these smart researchers got ahold of a trove of data on the use of telehealth services and asked how this option impacted patient utilization of health services.  Guess what?  The answer is ‘BOTH!’

They analyzed commercial claims data for 300,000 patients over a three year period (2011-2013) and looked specifically at people with acute respiratory illness.  These patients had access to a telehealth service as part of their plan and some of the folks with this illness used it, some did not.  ‘Hey, we don’t have toddlers, but we have an experimental group and a control group. Let’s publish a paper in Health Affairs because that is what PhDs do!’

The authors found that only 12% of the telehealth visits actually replaced a traditional visit.  The other 88% represented ‘new utilization.’  There were fancy statistical methods to confirm all of this (an admitted weakness in my recommended toddler protocol), but even though the telehealth visit is substantially cheaper than a comparable in-office visit, the extra utilization meant that the average patient who used telehealth actually incurred $45 more per year in costs than a patient who did not.  Whether telehealth meant more people found it easy to call and check on their cough, or the telehealth provider recommended the patient follow-up with an in-person visit just to be sure, the net effect was more utilization and more cost, not less.

Of course, we are early in the evolution of telehealth, so we might expect this finding to improve over time and that would be a fair hypothesis.  But it is worth noting that improved access, a laudable goal, sometimes comes with increased cost, not a goal at all. 

Unlike the toddler, we don’t always get to yell, ‘BOTH!’  Sometimes, we have to pick.

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ALN

Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

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