Healthcare scorecard, El Paso v McAllen
The interesting thing to me is not that McAllen is different from elsewhere. it’s that El Paso is different than McAllen. They have the incentives to go in that direction! My hypothesis is that communities have local anchor institutions that foster values and norms that make the medical system successful. My sense is that in McAllen it was about a few institutions striking out in different ways that set the norm for what others did.
In the early 90s, McAllen was the same cost as El Paso. Three years later, they jumped into the top 10 or 20 and never really left. The first thing to really leap in price was home health care and it happened, it seems, because a few home health agencies came on the scene and began offering doctors something serious for their involvement: extra salaries as medical directors who don’t really do much. McAllen is also on the leading edge of for-profit innovations. They were early with a specialty hearts center, for instance, and cardiovascular operation rates began climbing. Then you had physician-owned imaging centers and physician-owned surgery centers and everything began going up a lot.