Wednesday, November 14, 2007

Against Rogue Pros

How many of you are damn sure that whenever you go to those fancy hospitals and health clinics in Jakarta, without medical insurance in hand, you are not ripped off by those, favorite, doctors? That, somehow, you feel that your headache is not that bad, but then you find yourself ended up into unecessary expensive procedures as well as pricey medicines? That you are sure that caesarean section is indeed in dire need, and not the way obstetricians make extra money off you? And, --this is is the worst--, that they really know what's going on inside your body?

But since you have no expertise in medical science, the only option for you is to shut your mouth up, and let the experts decide your fate. Worse still, they are the one who not only diagnose, but also will be paid for further treatment.

The same thing goes for laptop repair, or car mechanics. And this guy, Henry Schneider of Cornell, took the challenge to prove whether car mechanics, in 40 Connecticut garages, don't swindle their costumers. The result: only 20 percent pass the test.

I hope somebody's gonna hire economists to do the same undercover research for health services here in Jakarta, or Indonesia, instead of relying on anecdotal evidences and finger-pointing game on doctor's malpractices. Schneider's paper and model is not technically too complicated to replicate for our case.

I am looking forward to it.


  1. Rizal:
    Read till the end. For obvious reasons -- you can't "damage" yourself in an obvious way while ensuring that the rest of you is in perfect health -- it's damn hard to do it for the health care industry.

  2. Arya, I did read it and am fully aware about the problem. Of course you can't be pregnant fourty times, only to test whether obstetricians rip you off.

    But there should be some other less damaging ways. You can hire not only one, but several surveyors to have "faked less harmful" physical illness --I'm thinking of small dose diarrhea--; and pay them handsomely for that "temporary suffering" :-).

    Or you can pay persons having similar health problem to consult several physicians and check the consistency of their diagnosis, suggested treatments, and price. You get the data, they more information from the "expert" --if not becoming more confused.

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  4. At the heart of this experiment is the way he found "how to mess up car in a couple of serious but obvious ways". In the case of cars, it is not impossible to establish that a car is 'healthy' except for the 'faked' problem. I don't see how to do this for human health.

    It's hard to see how to replicate this experiment for health care: 'messing up' participants breaches experimental ethics. But not only that, because human bodies are very complex, I suppose it will be hard to say that a doctor's call is based on malice, instead of differences in (or lack of) experience.

    Your second suggestion won't work either. Since when democracy is the way to establish "truth" in the medical sciences? Haven't you been watching House M.D.? ;-)

  5. Arya, thanks. I also don't know the suitable design for human health. Not yet. But I hope somebody will.

    On experimental ethics, I don't have much to say about that, too. Is voluntary testing for a new medicine, risky as it is, ethical? Is selling your other kidney voluntarily ethical?

    On "truth". We don't want a "truth", but a pattern. If, say, doctors make systematic diagnoses (that who knows later on, it is proven as scientifically wrong), then we can say perhaps their education in med school says so --hence, not a rip-off.

    We want a consistent and systematic diagnose and treatment on specific symptom, and accordingly, not an erratic skyrocketing pricing.

  6. Presumably, an easier experiment to test to what extent and in what matters experts are reliable, would be asking a bunch of indonesian economists to predict, say, indonesia economy according to some indicators. then compare economists' prediction to the prediction made by randomly selected people.

  7. Roby, it'd be a good idea.

  8. Rizal and Roby,
    It's a terrible idea. Why bother? We don't need an experiment to show that economists aren't forecasters -- because they aren't.

  9. Going to fancy hosp & med centre, we should necessarily buy medical insurance. Don't have one? Just go to public hospital, puskesmas or cheap GP in your neighbourhood. Make sense?