Math Nerd

Closing the Teach For America Blogging Gap
Sep 21 2012

“Controlling” for Poverty in Medicine and Education

When I told my family I was doing some research on using quantitative data to evaluate teachers, my father-in-law, a doctor, told the following story (I’m paraphrasing):

“They use formulas in medicine, too. It’s so unfair! Medicare dinged our hospital because our 30-day readmission rate for heart attack patients was too high. We had to send some of Medicare’s reimbursement money back to Medicare because they thought we weren’t doing a good job. But the thing is, their formulas don’t control for the socioeconomic status of the patient. They control for how sick the patient is when he arrives, but not what ZIP code he’s from or what ethnicity he is.

“It’s ridiculous. A lot of our patients are poor. Even though we write them a prescription for heart attack meds, they won’t fill it because they can’t afford it. We started focusing the drugs available on Wal-Mart’s $4-prescription list, but a lot of our patients can’t get to Wal-Mart because they don’t have cars. So then they get sick again and have to come back to the hospital. We can’t control what our patients do when they leave us. Why should we be penalized for this when other hospitals with wealthier patient populations don’t have this problem?

“Our finance people looked at the problem and realized it would be cheaper to just give patients the medicine ourselves than it was to pay the fine. So now we give heart-attack patients their medicine before they leave the hospital, and our readmission rates have gone down. See? It’s not rocket science. If people get their medicine, they come back less! Why didn’t Medicare realize that socioeconomics matter and factor them into their formulas?”

Hearing his story, my knee-jerk reaction was to agree with him. It did seem unfair that his hospital had been punished, since it was just following the usual procedures. But the more I thought about it, the more I liked how Medicare used its considerable weight to encourage the hospital to deliver better care to its patients. After all, it was unfair that they were sicker just because they were poor.

There are so many parallels to this situation in education. Schools serving poor students can’t just follow the usual procedures if they want their kids to succeed at the same rates as more affluent children do. It’s unfair to punish hard-working teachers just because their students are disadvantaged. But at the end of the day, it’s also unfair to students that they don’t learn the skills they need to thrive. How much responsibility should schools take for this? When, if ever, is it okay to say, “we’re doing the very best that we can, and that’s pretty darn good considering the circumstances”?

Even once a school decides to go above and beyond, there are still huge obstacles. The big questions are (1) is there a clear solution? and (2) is there money to implement that solution? In the hospital’s case, there were both. There was an easy solution – to give patients their pills – and, while the hospital isn’t happy about giving up some of their profits, as far as I know they’re still doing just fine financially. In education, the answers aren’t always as clear, and the money often isn’t there.

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