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. 2009 Nov;5(2):14-24.

There's No Reason for It, It's Just Our Policy

Robert G Evans

There's No Reason for It, It's Just Our Policy

Robert G Evans. Healthc Policy. 2009 Nov.

Abstract
in English, French

On June 1, 2009 the town of McAllen, Texas rose to brief prominence on the American political stage. With the highest (bar Miami) per-beneficiary costs in the entire US Medicare program, it was featured in an essay in The New Yorker by Atul Gawande, then seized upon by President Obama: "This is what we have to fix." Behind the headlines were decades of documentation of clinical practice and analysis of regional variations by John Wennberg, Elliott Fisher and their colleagues, and by Leslie and Noralou Roos and theirs. The implications for health systems were grasped over 30 years ago and have been confirmed by more recent work. Efforts to understand these variations within standard economic theory have, however, had limited success.

Le 1er juin 2009, la ville de McAllen, Texas, a fait la manchette sur la scène politique aux États-Unis. Elle présentait les plus hauts coûts par bénéficiaire (mise à part Miami) du régime d'assurance-maladie (Medicare) aux États-Unis. Le cas de McAllen a fait l'objet d'un article écrit par Atul Gawande dans le New Yorker, puis a été repris par le président Obama comme exemple de ce qui « doit être corrigé ». Derrière ces grands titres, il y avait des années de documentation sur la pratique clinique et d'analyses sur les variations régionales effectuées par John Wennberg, Elliott Fisher et leurs collègues ou par Leslie et Noralou Roos et leurs collègues. Les implications pour le système de santé ont été dégagées il y a plus de 30 ans, puis confirmées par des travaux plus récents. Cependant, les tentatives pour comprendre ces variations dans le cadre des théories de l'économie ont connues bien peu de succès.

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