Can We Talk About Healthcare?
I have been searching around for a data set that chronicles costs for Georgia Medicaid. Haven’t found it yet but I’m still looking. Feel free to send it to the tip line if you know where to find it. Specifically, I’m looking for individual procedure at individual hospitals. Chargemaster data is great, negotiated rates would be even better, but I digress.
I was pleasantly surprised in this search to find that Georgia has started to copy the federal government on transparency and there exists a Georgia version of Data.gov. So far it is woefully inadequate, but I blame that on policy makers who think the plural of anecdote is data and not on the engineer(s) that has(have) cobbled together a site on what I’m sure is a shoe string budget and the server is held together with 100mph tape and bubble gum. Perhaps, it is also powered by a hamster wheel as a further cost saving measure. Data can be enlightening, but you actually have to invest in collecting and storing it to gain its benefits.
A data set that I did find was a physician’s workforce data set. While modest, it does provide some interesting insight into rural healthcare delivery. For instance there are 9 counties that don’t have any of the basic doctors in them. No family medicine, internal medicine, emergency medicine, OB/GYN, or pediatrician. I’ll say that again. Chattahoochee, Echols, Montgomery, Schley, Talbot, Taliaferro, Treutlen, Turner, and Webster counties don’t have ANY doctors. None. Nada. Zilch.
Another interesting tidbit is that for a state with an over abundance of leaders who claim to be pro-life, and will proudly state it at a county GOP event even when it has nothing to do with the office they currently hold or are running for, there are 82 counties (more than half) that do not have an OB/GYN. That means that if something goes sideways and you/your pregnant partner are in one of these counties, mother and baby may not make it through the birth alive.
Go figure as to why Georgia has one of the worst Infant and Maternal Mortality rates in the country. Half of our state doesn’t have access to the relevant knowledge and experience to prevent infant and maternal deaths. “But Eric” you may say “Don’t all med students go through an OB/GYN rotation?” Yes that’s true, but of those 89 counties, 39 don’t have an internist. If you’re in Quitman county, better hope the single ER doc in the county paid close attention that semester.
This is simply a cursory look at one modest data set. I’d like to compare it to some others that would provide some more insight. I’d love to be able to show the variability of cost for various natal procedures and services, but that data is hard to come by. Georgia Medicaid doesn’t have it on their data portal and there appears to be a data set available that would have provider level data across the state but it costs about $1000 per data year/state and for Georgia, there is a unique provision that requires permission from the Georgia Hospital Association for the data to be released. This seems like an odd requirement to me, especially given that Georgia is the only state that has such a requirement.
At this point you may be asking “That’s a nice rant you’ve got there Eric, but what do you want to do about it?” And that’s a fantastic question. First, would be expand Medicaid so that rural practitioners can get paid and we don’t lose a hospital every year. Even former Governor Deal staffer Brian Robinson has been arguing for expansion, and Brian is solidly in the median of the Republican Study Committee. Before President Trump was elected in 2016, Georgia had done a pretty deep dive with various stake holders on how to expand Medicaid. Then when Trump was elected that entire plan went out the window and our solution was a waiver that had more in common with a last minute term paper than a properly well researched and thought out policy proposal.
Second, would be to free the data. While we learned in March/April of 2020 that data analysts are not the same as epidemiologists for coming up with actionable policy, we did learn that with open data we could get a variety of analyses that could generate some pretty awesome visualizations and insights. Looking at you Johns Hopkins. In their case they were relevant experts that had collected open data and could make meaningful interpretations of that data.
Am I a relevant expert? On some things, but I am definitely a nerd that loves to play with data. Other nerds that also like to play with data will have different levels and areas of expertise. This should be seen as a value add by policy makers. Like the open source software movement or bug bounties for cyber security, more eyes looking will find more problems that need to be addressed. With more eyes looking there will definitely be a few more of the right eyes looking that will help to find innovative solutions to those problems.