Correspondence
Doctors' Estimates of U.S. Health Care Spending
N Engl J Med 1993; 328:1202April 22, 1993
- Article
To the Editor:
It is estimated that U.S. health care expenditures for 1992 totaled $838.5 billion, or 14 percent of our gross domestic product (GDP). On January 6, 1993, the day this information was presented in a front-page story in The New York Times, I casually asked 15 colleagues who had not yet heard the report (9 cardiologists in academic medicine, 4 cardiologists in private practice, and 2 cardiology fellows) to estimate these figures. Their responses are summarized in Table 1Table 1
Estimates of U.S. Health Care Expenditures in 1992..There was no significant difference between the mean estimate and the value reported in the newspaper. But the relative error (the standard deviation divided by the mean) for the dollar estimates was five times greater than that for the percentage estimates (2.0 vs. 0.4).
The range of the dollar estimates was particularly astonishing (from $1 billion to $4.5 trillion). An annual expenditure of $1 billion is equivalent to an expenditure of $32 per second, whereas an annual expenditure of $4.5 trillion is equivalent to an expenditure of $142,694 per second. On this scale, the actual spending rate was $26,589 per second.
Similar magnitudes of number numbness have been reported among physicians with regard to their quantitative assessments of the risks associated with a variety of procedures and medications1. Such innumeracy2 is likely to have important practical consequences.
2 ReferencesGeorge A. Diamond, M.D.
Cedars-Sinai Medical Center, Los Angeles, CA 900481
Kronlund SF ,Phillips WR . Physician knowledge of risks of surgical and invasive diagnostic procedures. West J Med 1985;142:565-569
Medline2
Paulos JA. Innumeracy: mathematical illiteracy and its consequences. New York: Hill and Wang, 1988.
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