I attribute my absence to me being abroad in England, but with connectivity being abundant these days it isn’t much of an excuse. In any event, the plan for the Spring semester is to track my medical school application process, including my battle with the MCAT on April 19th! The hope behind this is that it will provide something new out there for Pre-Meds to read while they too jump the hurdles of the medical school admissions process.

In addition to new content, I am also going to do some “spring cleaning” and get rid of all the irrelevant stuff that I have put up on here. Any suggestions or ideas as to what you want to see more of (or, less of for that matter) please drop some comments here!

Best of Luck for the Spring Semester!

Taking Our MedicineThe bad economics of switching health-care plans.

By Ray Fisman
Posted Friday, Sept. 7, 2007, at 7:29 AM ET In the long-simmering argument over what’s wrong with American health care, recent polls show that many people blame our market-based system of private health insurance. Private insurance companies are faulted for, among other things, failing to do enough to prevent disease. They have no incentive to do so, argue advocates for reform, ranging from Michael Moore in Sicko to some of the current presidential candidates. And yet if preventive measures today result in savings on treatment tomorrow, then what’s good medicine should also be good business.

Diabetes management is a case in point. If they get help early on in managing blood-sugar levels, diabetics can stave off later medical complications that may result in expensive hospital stays. Yet many of these preventive measures aren’t covered or encouraged by insurers. Instead, patients are forced to haggle over reimbursement for insulin pumps, and most are rationed only four test strips per day to monitor their blood sugar (sometimes enough, but often not). If better access to insulin pumps and blood-sugar monitoring will save money in the long run, why are insurers so miserly with their diabetes customers?

A recent study (not yet published) by researchers from Case Western Reserve and Carnegie Mellon University explains that the culprit in poor diabetes management—and the lack of preventive care in general—may be the very high rate at which Americans switch among insurance plans. It takes about a decade for insurers to recoup their investment in early diabetes treatment, and by then odds are that their customer has moved on to another health plan. Alas, a lot of this turnover may be built in to the way Americans get health insurance. And it’s the doing not of individual patients so much as their employers, who are always on the lookout to switch plans for lower-cost coverage.

How often do Americans switch plans? Using data from the Community Tracking Study, a national household survey on health-care delivery, the authors estimate that 20 percent of policyholders switch insurers each year. Based on more-detailed data from a large regional insurer, they calculate that annual turnover may run as high as 30 percent, far too high to make back the cost of pre-emptive diabetes care, or subsidized gym memberships, or other front-loaded investments in good health.

High turnover of insurance plans isn’t news to health-care providers. With coverage tied to an employer (or a spouse’s employer), every time someone gets married, divorced, or moves to a new job, odds are he’ll switch to a new insurance plan. But the five economists who conducted the new study show that this accounts for only half of all turnover—a surprisingly small share. The rest comes from entire employer groups switching among insurers.

Explaining the promiscuous relationship between employers and their health insurance providers presents a challenge to economic theory. Lots of insurance companies are out there vying for employers’ business, and in that competitive economic landscape we would expect the “law of one price” to prevail. That is, all insurance companies should provide the same low-priced health coverage. If prices go up, insurers would be expected to undercut one another in an attempt to steal customers, driving prices back down.

But the real-world market for health insurance contracts falls far short of this theoretical ideal. The “law of one price” assumes that health insurers are all peddling a similar product, and that it’s easy for customers to learn about and compare the various offerings available. But shopping for health insurance isn’t like buying a stack of 2-by-4s—you make a few phone calls to find the lowest price. It’s difficult and time-consuming to weigh the costs and benefits of insurance plans with different reimbursement rates for thousands of procedures, diverse physician networks, and differences in quality of patient care. In economists’ terms, the insurance market has “search frictions.” Since the search for alternative plans is expensive, companies get locked into a relationship with whoever happens to be their current provider.

What’s a costly headache for insurance buyers is a profit-making opportunity for insurance sellers. Insurers know that it’s hard for their customers to leave them, so they push up prices secure in the knowledge that employers will have trouble breaking free. So much for the law of one price—because of search frictions, big price differences across plans don’t get whittled away by rivalry.

The authors of the new study argue, somewhat counterintuitively, that it’s precisely these price differences that lie behind the high rate of employer switching. An employer may not be able to evaluate all competing choices, but it’ll look for ones that present particularly promising alternatives to its current plan. And every few years, it’ll find one. For large companies that effectively run their own insurance programs with the assistance of an insurance provider, this doesn’t happen very often. But the authors calculate that smaller companies that require full insurance coverage make a change on average every five years. In other words, while the law of one price doesn’t work well as a result of high switching costs, those costs are not so high as to prevent switching altogether.

Now that we’ve diagnosed the problem, can we develop health-care policies that will encourage preventive medicine? We could move to a system of universal health coverage, like Canada, France, Italy, and every other rich country on earth. That would get rid of turnover altogether. But it would also require fundamental changes to a system that has resisted major reform until now. And so as an alternative, the authors of this study suggest ways to tinker with the current model to reduce the search frictions that are responsible for much of the turnover problem.

Employers are tempted into switching because of price disparities across plans. A partial solution would be to legislate away these differences by capping what insurance companies can charge. This should reduce price differences between plans, and the incentive for employers to shop around for cheaper options. But where should the government set the ceiling? If it’s too low, the government could end up destroying insurance companies’ incentives to stay in business at all.

Another option is to make available a simple, easily understood, and reasonably priced health insurance plan. The authors argue that this would simplify an employer’s search for good insurance and as a result, reduce the amount of switching. They suggest that the federal government could create a plan that all employers could choose to offer their workers. The authors wager that while most employers wouldn’t use the federal plan, it would create the competition needed to drive down prices of private insurance. This modest proposal for government intervention won’t satisfy Michael Moore or others pushing for a complete overhaul of American health care. But it may help to make Americans healthier while we wait for more ambitious reforms that are promised every electoral cycle but so far never delivered.

by NICHOLAS A. CHRISTAKIS

Published: August 24, 2007

Boston

NO surprises” is a basic rule in hospitals. Junior doctors are supposed to notify their superiors promptly about worrisome developments in a patient, and information is supposed to move smoothly up the chain of command. One of the gravest errors a doctor in training can make is to inform the attending physician well after the fact about a patient’s turn for the worse.

Unfortunately, this rule does not extend to seriously ill patients themselves. They and their families are frequently surprised by the sudden imminence — and the raging authority — of death.

Research has revealed doctors’ tendency to contribute to the problem by avoiding making prognoses. In one study of nearly 5,000 hospitalized adults who had roughly six months to live, only 15 percent were given clear prognoses. In a smaller study of 326 cancer patients in Chicago hospices, all of whom had about a month to live, only 37 percent of the doctors interviewed said they would share an accurate prognosis with their patients, and only if patients or their families pushed them to do so.

Even when doctors do prognosticate, the research shows, they typically overestimate the time a patient has left to live, often at least tripling it, perhaps because they feel overconfident. The pugilistic attitude most doctors adopt toward disease is understandable, even desirable, for much of the course of illness. But there comes a time when this attitude can lead to false optimism. Doctors who wrongly think that patients are going to live much longer wind up recommending needlessly painful and expensive treatments. This phenomenon is neatly captured by a gallows-humor joke told by hospice nurses: Why are coffins nailed shut? To keep doctors from administering more chemotherapy.

By not making or communicating prognoses, doctors can make the end of life more unpleasant. Patients are given no chance to draft wills, see distant loved ones, make peace with estranged relatives or even discuss with their families their wishes about how to live the end of their lives. And they are denied the chance to make decisions about what kind of medical care they want to receive.

Roughly half of Americans die with inadequately treated pain. Large minorities suffer symptoms like shortness of breath, nausea or depression. Four in five die in hospitals and nursing homes, rather than at home as most prefer. And more than half significantly burden family caregivers in the course of their final illness: the family loses its life savings, a caregiver has to quit work or a spouse falls seriously ill.

For reliable prognoses to become a routine part of medical care they must become a priority of medical research and education. Less than 5 percent of research focuses on prognosis. Textbook descriptions of diseases cover prognosis less than 25 percent of the time. And medical schools and residency programs almost completely neglect training in prognostication.

Greater investments in new statistical tools and databases that help physicians predict outcomes are also needed. With these, doctors could translate the clinical, biochemical and genetic information they collect on their patients into statistical predictions of life expectancy that could supplement their own clinical judgment.

Doctors often say they worry that predictions about survival may become self-fulfilling prophecies or cause patients to lose hope. But a realistic assessment of how long a patient has to live need not cause either the patient or doctor to become pessimistic. It should only refocus attention on the quality of the patient’s life. Sometimes living life to its fullest requires knowledge of its finitude.

Nicholas A. Christakis, a physician and a professor of sociology at Harvard, is the author of “Death Foretold: Prophecy and Prognosis in Medical Care.”

In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.

Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”

Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.

“If a patient goes into the hospital with pneumonia, we don’t want them to leave with a broken arm,” said Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services.

The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the health industry.

It also raises the possibility of changes in medical practice as doctors hew more closely to clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission.

Hospital executives worry that they will have to absorb the costs of these extra tests because Medicare generally pays a flat amount for each case.

The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year — about 270 a day.

Intravenous catheters are widely used to provide hospital patients with medications, nutrition and fluids, but complications are relatively common.

One state, Michigan, has had spectacular success with systematic efforts to reduce infection rates in intensive care units.

Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group, said, “Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.”

Consumer groups welcomed the change. And while hospital executives endorsed the goal of patient safety, they said the policy would require them to collect large amounts of data they did not now have.

Lisa A. McGiffert, a health policy analyst at Consumers Union, hailed the rules.

“Hundreds of thousands of people suffer needlessly from preventable hospital infections and medical errors every year,” Ms. McGiffert said. “Medicare is using its clout to improve care and keep patients safe. It’s forcing hospitals to face this problem in a way they never have before.”

Christine K. Cahill, a registered nurse who used to inspect hospitals for the California Department of Public Health, said: “This is a great start. Infection-control specialists have been screaming for 20 years that federal and state officials should pay more attention to this problem because hospital infections hurt patients and cost money.”

The Bush administration estimates the new policy will save Medicare $20 million a year. But other experts say the savings could be substantially greater.

Nancy E. Foster, a vice president of the American Hospital Association, agreed that doctors and hospitals knew how to prevent the transfusion of incompatible blood products and should not be paid more if they accidentally left objects in patients during surgery.

But Ms. Foster said that some of the conditions cited by Medicare officials were not entirely preventable. Commenting on the proposed rules in June, the American Hospital Association said, “Certain patients, including those at the end of life, may be exceptionally prone to developing pressure ulcers, despite receiving appropriate care.”

In most states, Ms. Foster said, hospital records do not show whether a particular condition developed before or after a patient entered the hospital. Under the new rules, she said, hospitals will have to perform more laboratory tests to determine, for example, if patients have urinary tract infections at the time of admission.

Dr. Tammy S. Lundstrom, the chief medical officer at Providence Hospital in Southfield, Mich., said, “The rules could encourage unnecessary testing by hospitals eager to show that infections were already present at the time of admission and did not develop in the hospital.” Moreover, she said, “Serious, costly infections can occur even when doctors and nurses take all the recommended precautions.”

The rules, first reported in The Star-Ledger of Newark, carry out a directive from Congress included in a 2006 law. When they were proposed in May, consumer advocates said they feared that some hospitals might charge patients for costs that Medicare refused to pay.

But that is forbidden. “The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,” the final rules say.

Eileen O’Neill-Pardo of Everett, Wash., said her experience showed the need for the rules. Her 82-year-old mother, Margaret M. O’Neill, died of an infection that developed during intestinal surgery at a Seattle hospital in 2004.

“The operation — to remove scar tissue — was successful, but the patient died,” Ms. O’Neill-Pardo said. “The hospital staff did not take steps to control the infection, which took over her body. My mother died less than a week after the operation.”

Michigan hospitals have been extremely successful in reducing bloodstream infections related to such catheters, researchers reported recently in The New England Journal of Medicine. The hospitals did not use expensive new technology, but systematically followed well-established infection-control practices, like covering doctors and patients from head to toe with sterile gowns and sheets while the catheters were inserted.

Hospital executives said these techniques had saved 1,700 lives and $246 million by reducing infection rates in intensive care units since 2004.

Some of the complications for which Medicare will not pay, under the new policy, are caused by common strains of staphylococcus bacteria. Other life-threatening staphylococcal infections may be added to the list in the future, Medicare officials said.

Dr. Kenneth W. Kizer, an expert on patient safety who was the top health official at the Department of Veterans Affairs from 1994 to 1999, said: “I applaud the intent of the new Medicare rules, but I worry that hospitals will figure out ways to get around them. The new policy should be part of a larger initiative to require the reporting of health care events that everyone agrees should never happen. Any such effort must include a mechanism to make sure hospitals comply.”

While the idea behind the legislation makes sense, I agree with the skeptics that by holding hospitals more accountable for hospital-aquired ailments,  hospital administrations are likely to pressure their physicians to order more tests to check for any secondary health problems the patient brings with them to the hospital. It will be interesting to see how much net money is saved after factoring in the cost of running more tests.

Want to understand more of what you read – even if the material is somewhat above your head? No problem – just follow educator Ann McNeal of Hampshire College’s four-step guide for reading a research paper.

Now, while her tips primarily apply to students trying to slog their way through academia, anyone who wants to read with more comprehension will get something out of this. Basically, the tips boil down to skimming, deciphering vocab, attempting to comprehend, and then criticism/reflection. A good set of reminders for anyone who wants to get more out of their reading.

‘How To Read with More Comprehension’ from Hampshire College, via Lifehacker.com

With that being said, I am going to start shifting the focus of this blog. I I posted some content early on that was relevant to university life in general, but probably wasn’t very interesting for the neurotic pre-med. I am going to try and aim future content more towards the original goal for this blog and have everything relate to medical school as much as possible.

Any feedback would be greatly appreciated! Thanks a ton!

“Writing Links & Links for Writers” at Internet-resources.com, via Lifehack.com

The Pre-Allopathic sub-forum of SDN is complete heaven for the neurotic pre-med types (like me!).

Pre-meds and medical students from all over (there are upwards of around 120,000 SDN forum members!) come to this site to spread advice and share their medical school application experiences.

A caveat: you need to be careful and take some advice you find on there with a grain of salt. For example, in the “What is more important, GPA or MCAT?” thread there are many pre-meds who voice their opinion, yet those pre-meds really have no real knowledge of this stuff. I will try to post some of the better pieces of advice on here!

Enough already, go visit the site and get lost in the forum’s 1.3 million posts.

I apologize for the lack of new content yesterday, but it was a holiday (in Canada) and I promised myself to stay away from the computer as much as possible.

Wouldn’t it be great to crunch 6 hours of audio material into a 90-100 minutes? Just think how many more audio books or podcasts you could squeeze into your week. According to Steve Pavlina at ‘Steve’s Pavlina’s Personal Development Blog’, we have the ability to think faster than people talk. He suggests that we could speed up the rate of listening to  our favorite audio by around three to four times normal and still retain all the material we listen to.

While it sounds like it might work in theory, I will have to try this out before I give it an endorsement. If any of you use have tried this technique, let us know if it worked for you!

An excerpt:

Did you know that if you have 60 minutes of audio material to listen to, you can very easily digest the material in 30 minutes or less?  And with practice you can even get it done in less than 15 minutes.

Modern media players can play audio at faster rates than the default, and they’ll automatically adjust the pitch so the voices sound faster but not squeaky.  Some players provide this feature via a plug-in.  Windows Media Player has this feature built in.

Check out “Overclocking Your Audio Learning” at StevePavlina.com

Welcome to college. No one is here to make sure you study, do your homework or, heck, that you even get out of bed in the morning. This new-found independence also means you’re responsible for managing your own money and making daily financial decisions. So while you may think you have all your essential back-to-school gear — backpack, computer, number-two pencils — you’ll want to make sure you bring along must-have item number-one: Good money sense.

Here are ten things all new college students should know about making smart financial choices when they first arrive on campus.

1. Know what your parents are paying for and what you are expected to cover. Before you box up your room, you need to sit down with Mom and Dad to talk about money. If they’re footing the entire bill, you need to discuss your monthly spending allowance and how the bills will get paid. If you’re picking up part of the tab, you need to know what specifically you’re responsible for, and brainstorm ideas to help you cover your share. For example, will the money come from your savings, an on-campus job or student loans?

2. Understand your financial aid. Make sure you know what is required of you to keep your support. Some scholarships, for example, require you to maintain a certain GPA, and some work-study programs may not allow you to get a second job anywhere else. Make sure you know the rules, advise the experts at the National Endowment for Financial Education. Also, scholarships aren’t just for freshmen, so watch for scholarship opportunities throughout your college career.

3. Choose the right bank. One of the first things you should do upon arriving on campus is to set up a checking account. This will allow you to pay bills and manage your spending cash effectively so you won’t have wads of crumpled up bills in your pocket — or lying around your dorm. Make sure your checking account comes with a free debit card and requires a low minimum balance to avoid fees. If you can find one that pays interest, that’s a great bonus because your money will grow while it sits in the bank. Select a bank with plenty of ATMs on campus so you can get cash without having to pay an extra buck or two every time you use another bank’s machine.

If you don’t know how to balance a checkbook, now is the time to learn. If you bounce a check — that is, write a check without enough money in your account to cover it — you’ll have to pay an extra $20 or $30 every time. That can really add up. Basically, you need to write down how much money you have in your account, and every time you spend something by check or debit card, you subtract the amount to keep a current total. It’s not tough; it just takes a bit of discipline. Which brings us to our next point…

4. Watch where your money goes. A budget sounds so stuffy, but it can be a beautiful thing. It allows you to know where you’re money is going each month so you can make sure you have enough for the things you need, and perhaps a few things that you want. It’s easy to fritter away loose change on sodas and treats from the vending machine. But all those little costs can add up big. Say you spend $3 every morning on a latte. In one month you’ll have spent about $90. If your school offers a student card that doubles as a debit card on campus, keep a close eye on that spending too. See Beyond Tuition to find out more ways to plug the leaks in your spending, including tips on cutting expenses for food, text books and phone service. And use our college budget worksheet to estimate your living expenses while away from home.

5. Don’t put the entire semester’s money in your bank account at once. If your parents are pitching in for your living expenses — or you plan to cash out savings or investments to fund your own education — don’t put all the money into your checking account at the beginning of the semester, advises Patricia A. Konetzny, a CFP in Maynard, Mass. Even with the best intentions all that extra cash could create too big a temptation. Better to roll it in on a monthly basis to cover your costs to make sure you have just as much money for the last month of the semester as you had for the first. Make it easy on yourself — or Mom and Dad — by arranging with your bank for each month’s share to transfer automatically into your checking from a linked savings account on the first day of the month.

6. Just say “no” to credit cards. At least for now. Sure, you’re 18 and legally able to get a credit card on your own, and lenders will be all too eager to give one to you. But that doesn’t mean you should take the bait. It’s so easy to fall into the credit card trap and find yourself relying on them too much. According to student loan provider Nellie Mae, 76% of all college students started the 2004 school year with a credit card — and the average balance they carried was nearly $2,200.

But because it will be easier for you to qualify for a card while in school than after you graduate, you will want to get a card before you don your cap and gown to help you build up a credit rating, advises Janet Bodnar, who writes the Money-Smart Kids column for Kiplinger.com. However, you should wait until your junior or senior year to avoid getting in over your head. By using your checking account and debit card for the first couple of years, you will “acquire both experience managing money and the maturity to pay your bills on time,” says Bodnar.

7. Be smart about roommates. You may not be able to choose your roommates, but you can take steps to protect your finances from one. Take the long-distance phone bill for example. If your roommate talks to Mom in Australia every night and you make only a monthly call home to Texas, splitting the phone bill 50/50 won’t make much sense. Some dorm rooms will allow you each to set up separate long-distance accounts where each of you must enter a PIN before placing a call. If you live off campus, some utility companies will allow you to arrange for a similar setup. Another option is to get separate phone lines entirely or rely on pre-paid calling cards or your cell phone.

Once your roomies move in, you may find that you’re short a few essential items, such as cleaning supplies, a lamp or a TV. It’s better for each roommate to buy an entire item on their own instead of splitting the cost. That way you’ll avoid arguments over ownership later. If you do decide to share the cost on any item, however, make sure you are all clear about who gets to keep it at the end of the year. And if your roommate wants you to buy something that you don’t think you’ll use or you can’t afford, just say no. See Winning Roommate Roulette to learn more about the financial ins and outs of sharing your space.

8. Protect your financial information. You don’t want to leave cash, credit cards or other valuables lying around your dorm. So you’ll need a little more protection than your sock drawer can offer. While you’re out shopping for your dorm gear, pick up a small safe (for about $100). You can use it to store your Social Security card, passport, credit cards, loose cash and other sensitive stuff from prying eyes and sticky fingers.

9. Take advantage of free or cheap entertainment. It may seem as if your education is eating up every last dime, but you don’t need a lot of money to have some fun. Start by hanging out on campus and taking advantage of student art shows, musical concerts, theater productions and student film festivals. Or do some stargazing at the college observatory. These activities are often free or very inexpensive, so you could even afford to bring along a date.

You can also check for last-minute bargains on local concerts, plays and other events. When it gets down to a couple hours before a performance, the theater may start selling “rush” tickets at a fraction of the price — it would rather sell the seats at a bargain than let them go empty. Consolidated discount ticket booths are popping up in cities nationwide, including Austin, Boston, Chicago, New York, San Francisco and Washington, D.C. It’s also a good idea to ask your favorite venue about other discounts, such as standing room only, matinees and pay-what-you-can nights. Or team up with a group of friends to snag a group ticket rate. (See Entertainment for Less for more money-saving tips.)

10. And don’t forget student discounts. One of the perks of being a perennially broke college student is that many venues are happy to shave a few bucks off admission for you. Ask about student discounts at the local movie theater, playhouse, amusement park or concert hall. And of course, you can get sharply discounted tickets to your school’s sporting events. Plus, student discounts aren’t limited to entertainment. Ask if your car insurer offers a discount on your premiums, or if your bank has any special promotions for college students.

Do you have any cost-saving tips that you would like to add? Free free to do so in the comments!