I recognize that you can’t include every aspect of a story in every article about the story. But some stories leave so much out that, like a fan dancer’s fan, they appear to be intended to reveal but are actually intended to conceal.
That’s how I felt about this story at RealClearHealth:
The cost of keeping American kids physically and mentally healthy increased 56 percent between 1996 and 2013, a new study finds.
Health care expenditures jumped from nearly $150 billion in 1996 to more than $233 billion in 2013 for those 19 and younger, researchers found.
Here’s what’s left out: they never define whether they’re talking about real or nominal spending. Without that you can’t tell whether spending is going up, down, or staying the same. $150 billion in 1996 is about $230 billion today which would mean that if they’re talking in terms of nominal dollars spending is unchanged. In per capita terms $1,915 in 1996 dollars is about $2,946 today so per capita spending of $2,777 would mean that per capita spending has actually gone down.
I could determine that by searching out the original study and purchasing it but I shouldn’t have to. That information is basic in good economics reporting.
Since there are as many as 4 million more children 13 and under than there were in 1996 and the total spending is unchanged in real dollars that would mean that per capita spending is actually going down which is supported by the figure reported.
Here are some other things left out of the report:
- Is the difference mostly in private or public spending?
- How has the change in spending affected outcomes?
- What is the difference in procedures performed per patient?
- How does that spending break down by the income quintile of the parents?
There’s a vague statement about outcomes but not nearly enough to draw any conclusions from.
Maybe this should be filed under “Why, oh why isn’t there better healthcare reporting?”
There is one interesting little snippet in the article:
By 2013, nearly $28 billion went to newborns in the hospital. Spending on ADHD reached almost $21 billion. Dental care commanded $18 billion, and asthma reached $9 billion, Dieleman said.
By contrast, spending on childhood ADHD in 1996 was just under $8 billion, Dieleman said.
That’s a sharp increase whether nominal or real and, honestly, it touched a nerve. I wonder how much of that additional spending on ADHD is targeted at making little boys behave like little girls, i.e. sitting still and playing quietly?
Here are some other little factoids, not from the article. In the United States we spend less on children and young adults’ health as a share of total healthcare spending than any other OECD country. And we spend a lot more on elder care.
We resisted putting our daughter on Ritalin for ADD (No ‘H.’) We asked the doctor how this was anything other than using drugs to force a kid to keep pace with her age cohort. To which he answered, “Of course that’s what it is.”
Without going off on a long rant, let me just say that the choices parents make are infinitely more complicated than they appear to outsiders. Kids aren’t widgets.
“Maybe this should be filed under “Why, oh why isn’t there better healthcare reporting?†”
You mean something requiring basic facility with data analysis, formulation of logical questions and logical inferences? Surely, my good fellow, you jest. THAT won’t sell ad space or clicks.
As for elder-spending, I’ve long believed it due to outsourcing to third parties so as to not crimp boomer’s lifestyles, and to the inability of people to come to terms with end of life realities. As just one example, my sister, who died a cancer death, effectively passed away long before the body died. At what cost I can only imagine.
Boomer lifestyles? This spending way preceded the boomers retiring. As to end of life spending, you think we could get Republicans to relent and put back in payment for end of life counseling? I think Palin has been out of the picture long enough that she shouldn’t be able to convince people that this means death panels again. Some days I get really tired of torturing old people to death.
Steve
Heartily agree with Michael on the issue of meds for kids.
There is some emerging research on epigenetics and nutrition relating to a lot of neuro and mental health problems, and I suspect our crappy diets (relating both to dietary choice and to farming practices) are contributing to the epidemics of ADHD, autism, etc. One of my kids takes a neutraceutical, Vayarin, for ADHD symptoms. It’s basically good quality Omega fatty acids plus phosphatidylserine (the latter has some direct effect but also helps get more of the omega 3 delivered to the brain.)
We had our own anecdotal single blinded experiment at one point when I had trouble filling the prescription for about a month after he’d been taking it for a year or so. Suddenly all of his teachers were contacting me to find out if something had changed because his focus and executive functions had abruptly deteriorated.
For those unable to access the original article that Dave’s cited piece is reporting on……..
“The spending estimates for each type of care were scaled to reflect the adjusted annual health care spending reported by the NHEA. This procedure is common among health care spending researchers, as no single data source offers a census of spending in all health care settings.22,25 This scaling procedure assumes that the spending captured in the data used for this study was representative of spending in the total population. The encounter-level spending estimates were adjusted so that all spending estimates are reported in inflation-adjusted 2015 US dollars.26”
Steve
Thank you, Steve. That tells us that real spending actually increased. It doesn’t tell us whether that represented more care or just the same care at higher prices.
My closing point remains: other than by reading the original there was no way to determine that.