Friday, June 5, 2009

Learning from other high cost enterprises

Atul Gawande's piece, "The Cost Conundrum" in the New Yorker is startling. He describes McAllen Texas, one of the poorest, least healthy, and costliest (at least for health care) places in America. The cost isn't due to its distance from major cities, or its unique health challenges, but instead to four other things:
  1. McAllen physicians seem to be particularly entrepreneurial, seeking many ways to make money--through owning buildings, clinics, and stores instead of simply maintaining a practice.
  2. McAllen health care professionals are also particularly non-communicative, meaning that they are unaware of the high costs of health care in their town, unaware of what other physicians are doing, and unaware of the health benefits (or lack thereof) of particular medical actions.
  3. As a result of (1) and (2) above, McAllen physicians recommend far more tests and procedures than their counterparts elsewhere.
  4. As a result of (3), health care costs are unusually high in McAllen.

Physicians in healthier, less expensive places avoid (1) and (2) above, and therefore avoid (3) and (4). Instead they have created ways to share information about cost and treatment, and devote more time to patients as individuals, rather than patients.

The article got me thinking about cost in higher education. Education is one of the only other fields where costs have risen with a pace and force comparable to those in health care. And education, at least in many areas, follows the practices of McAllen physicians. We are entrepreneurial, non-communicative and non-cooperative (especially with colleagues from other institutions), and therefore our goal becomes to recruit and place students in programs (treatments) rather than meeting them where they are. (In addition, their funding streams are coming to look more similar every day, with the federal government paying out large portions of the cost of health care and education.)

Higher education lacks one thing that health care has--a clear measure of health. One of the things that physicians in low-cost high quality towns are certain about is how to help people manage their health. Educators lack this. We don't agree on what educational sickness looks like (is it the absence of a degree? a job? certain facts? certain habits of the mind?), and we don't agree on what educational health looks like.

In the absence of clear measures, can we learn from the story of McAllen? Can we focus on students as individuals with particular needs and desires? Can we shape education to meet those specific needs? Can we cooperate on outcomes and treatments so that we increase educational health and reduce its costs? And can we help students, parents, faculty, donors, legislators, and regulators think this through?


derek bitter said...

about the educational sickness bit. it's true that we don't all agree on what it looks like, and you might also say the same for educational health. What does that look like? There is a Neil Postman essay where he says that health is the absence of sickness or disease, and this is basically how doctors see it. And so he says that educational health should be the same. He says educators should aim to avoid things that make students stupid. I think this makes sense when you consider a body without sickness can only then develop and grow stronger, and so the same can be said for the mind.

Bryce said...

One thing that struck me in the article was Gawande's description of the "core tenet of the Mayo clinic" (the patient comes first). Like you said, this is what we're missing in education. We tend to have vague, abstract mission statements that aren't very useful in guiding practice or decisions.

My question is do we need a shared "core tenet" across higher ed? Or, would institution-specific missions (concrete, specific, measurable missions) be enough?

The pessimist in me thinks that we are a long way from ever having a nationally shared understanding of what it means to be educated.