Parsimonious

I dearest persimmons alongside their luscious flavour in addition to their rich exotic texture, merely parsimony has nil to do alongside persimmons. For the 99% of Americans who are less familiar alongside the term parsimonious than they are alongside the rare persimmon fruit, hither are the suggested synonyms to parsimonious, according to the Merriam Webster dictionary: “cheap, chintzy, close, closefisted, mean, mingy, miserly, niggard, niggardly, stingy, penny-pinching, penurious, pinching, pinchpenny, spare, sparing, stinting, tight, tightfisted, uncharitable, ungenerous”.

In the 6th edition of its article, despite this ambiguity, in addition to perchance exactly because of it, parsimonious tending is rapidly becoming a real pop term inwards the industry. In a NEJM article on costs of wellness care, Peter J. Neumann dares to inquire the query in addition to proceeds to answer it too: “Is “parsimonious” the correct word? Perhaps at that topographic point are meliorate ones, merely “frugal,” “prudent,” “thrifty,” “cost-conscious,” in addition to others would also enhance objections. … Calling it parsimonious is a reasonable start.” Yes, nosotros can’t actually telephone telephone it what it is because it would enhance objections. Similarly, nosotros can’t telephone telephone something a “tax” because it would enhance objections, in addition to then nosotros telephone telephone it “penalty” instead, in addition to this also is a reasonable start.

So what does parsimonious tending await like? There are no exact descriptions, presumably because they also would enhance “objections”, merely at that topographic point are philosophical principles involved. Dr. Zeke Emanuel, for example, is thrilled alongside the ACP daring to move “a professional person lodge unafraid of advocating the regulation of cost-effectiveness”. Cost-effectiveness, which has been inwards broad utilization earlier parsimonious came into vogue, is best examined at the edges where costs differ widely in addition to effectiveness is held constant, or vice versa. It is prudent to remain away from instances where both costs in addition to effectiveness vary widely inwards straight proportion to each other, because unopen scrutiny may enhance objections. Perhaps this is where parsimonious tending kicks in, invoking the renowned 80-20 describe of piece of work concern rule. If yous teach injured inwards an accident in addition to nosotros tin terminate restore yous to 80% functionality for 20% of the cost, should nosotros actually pass the ease 80% of the coin for a measly 20% inwards diminishing returns to society? 

We may move able to gain additional insight past times agreement what parsimonious tending is not. Influenza A virus subtype H5N1 much debated recent report published inwards Health Affairs concludes that for office-based physicians, electronic access to imaging in addition to lab results does non cut down the frequency of essay out orders, in addition to advises that “[i]nsurers in addition to wellness tending providers should also move wary of claims that computerization lonely volition Pb to a to a greater extent than parsimonious exercise style”. Disregarding the policy implications in addition to the validity of these conclusions, along alongside the vigorous rebuttals, in addition to sticking alongside our largely semantic analysis, nosotros may conclude that a reduction inwards ordering of expensive tests is a feature of parsimonious care. Examining the information inwards this study, which has non been questioned past times those taking number alongside the conclusions, 1 should move forthwith struck past times the fact that doctors inwards somebody solo exercise are most 4 times less probable to monastic say expensive imaging tests than physicians employed past times hospitals, in addition to significantly less probable to do in addition to then than doctors practicing inwards large grouping settings.

Since this item report took the freedom of making some pretty wild assumptions, in addition to since the rebuttals engaged inwards similarly wild predictions, perchance it would move beneficial to disregard the multitude of controversial trees in addition to discover the wood inwards patently view, which reveals that parsimonious tending is to a greater extent than probable to move delivered inwards small-scale somebody practice. The obligatory implications to policy makers would move to quit the mindless herding of doctors into unparsimonious infirmary occupation in addition to consolidation, in addition to to bear some studies of readily available information on the parsimony, or cheapness, of tending inwards diverse exercise settings. The Definition of parsimonious care, at to the lowest degree for ambulatory practice, equally that which is offered inwards small-scale somebody exercise settings, in addition to the advertisement of the same, is guaranteed to non enhance whatever objections from the public. The choice would move to proceed using terminology nobody understands to construct policy nobody understands, piece engaging inwards esoteric conversations for the illuminati who possess the encryption keys to world discourse.

Addendum: For the sake of completeness, hither is the brand novel response from the authors of the Health Affairs report on imaging, to the ONC rebuttal. (3/12/2012)