Doctors

Children's Health, Today and Now

The New York Times wrote a piece looking back on the accomplishments and frustrations of Dr. Irwin Redlener, one of the founders of the Children’s Health Fund, who is stepping down from his administrative position this week.

 

Dr. Redlener’s team began the Children’s Health Fund in 1987 as a response to the poverty he saw in NYC. Today, it has more than 50 mobile pediatric clinics nationwide, and it is an important model for other initiatives in urban areas where poverty and systemic inequality endanger the health of children. Dr. Redlener lived his life to his word when he said, “life and work are based on a simple message: Kids can’t wait.” He points out that the consequences of failing to address a child’s health needs at each stage of development are real and irreversible. For example, failing to treat a child’s ear infection with antibiotics - a relatively simple thing to do - can lead to hearing loss in the long run, which is both a personal disability and a societal cost.

 

In NYC, the number of children living in city shelters have doubled since 1986. According to the New York Times, there are about 22,000 children living in city shelters today. This statistic has grave implications for children’s health. If these children do not have homes, their nutrition, education, and immunizations are all at risk. Economic factors have worsened the housing situation in NYC for the poor over the past few decades, and society has not come up with sufficient mechanisms to compensate for that.

 

Instead, at the national level, lawmakers seem determined to chip away at the existing social safety net even further in cuts to Medicaid under the proposed healthcare bill. Dr. Redlener told the New York Times that such cuts would leave children in more danger than ever during his career of over 30 years. He said that politicians have certainly frequently debated the parameters of what Medicaid would cover, but to gut the program as it is now being proposed had never entered the picture.

 

It is clear that we are at a critical juncture for the future of children’s healthcare, especially for children living in urban areas. Prioritizing the health of children today means preserving the societal health of the future.

 

To learn more about Dr. Relener and his work, read the full New York Times article. You can also read his upcoming book, "The Future of Us: What the Dreams of Children Mean for Twenty-First-Century America,” which will be published this September.

Economics, Doctors, and Us: A New Kind of Medicine?

A physician wrote a piece in the New York Times recently that is very relevant to our mission and work here at CHIL. Dr. Khullar writes that years of medical and scientific education often do not influence his decisions as much as his patients’ habits and environmental cues. If anything, a decade of diverse and intense training has made him more attuned to noticing subtle “nudges” and cues that incentivizes him to provide the best care he can, or incentivize his patients to be proactive about their health care.

 

According to Dr. Khullar, the field of behavioral economics holds that “human decision-making [often] departs” from what might be expected if agents behaved “rationally.” This description seems to characterize medical care as well, where all sorts of factors (emotions and uncertainties, for example) can complicate medical decisions. Despite this connection, Dr. Khullar says that members of the medical community have “only recently” begun exploring how behavioral economics can improve health. This is a crucial change, since medical experts bear an enormous responsibility in how they present care options to patients and how they encourage patients to pursue treatment options. For example, the framing of default options as opt-in or opt-out can have a huge impact on how healthcare is delivered to patients.

 

Pioneers in linking behavioral economics, decision-making, and medical care are focusing on designing randomized trials or applications to tackle some of the basic, and difficult, challenges in healthcare. Dr. Khullar names some of these challenges as encouraging doctors to provide evidence-based care, incentivizing patients to take their medications (a form of preventative care), and aiding consumers in choosing better health plans that were more comprehensive for their needs. Innovators are also using these challenges as opportunities to create applications to, for example, reward patients for submitting pictures of themselves taking medications each day. These designers create program infrastructures that reward patients for weight loss goals they establish by entering them into lotteries or deposit contracts. Health insurers are jumping onto this wagon as well, and researching goals for patients and doctors to meet when it comes to diseases like diabetes management.

 

The title of the New York Times piece is “How Behavioral Economics Can Produce Better Health Care.” This title leaves out some crucial actors in the study and delivery of a marriage between behavioral economics and health research. Doctors, patients, and economists each play a distinct role in identifying and acting on potential improvements in healthcare delivery. Projects like the ones we have at CHIL are designed with students as patients in mind - behavioral economics isn’t only for economists! We can all use a project-oriented approach to improve our health.