I’ve been quite critical of the Make-A-Wish Foundation in the past. It’s pretty much the opposite of what you’d do if you were trying to design a highly effective charity.
Does it target the people most in need? Not really. While it’s aimed at terminally ill children, it doesn’t work in the world’s poorest countries.
Does it help the people in need most? Again, no. It does not try to save lives. It does try to inject a little joy into the lives of sick kids, sometimes — as in the famous case of the Batkid in San Francisco — at considerable financial cost.
The average wish costs $10,130 to fulfill. Given that Malaria Consortium can save the life of a child under 5 for roughly $2,000 (getting a precise figure is, of course, tough, but it’s around that), you could probably save four or five children’s lives in sub-Saharan Africa for the cost of providing a nice experience for a single child in the US. For the cost of the heartwarming Batkid stunt — $105,000 — you could save the lives of some 50-odd kids.
But now I’m reconsidering. A new study in the journal Pediatric Research, comparing 496 patients at the Nationwide Children’s Hospital in Columbus, Ohio, who got their wishes granted to 496 “control” patients with similar ages, gender, and diseases, found that the patients who got their wishes granted went to the emergency room less, and were less likely to be readmitted to the hospital (outside of planned readmissions).
In a number of cases, this reduction in hospital admissions and emergency room visits resulted in a cost savings in excess of $10,130, the cost of the average wish. In other words, Make-A-Wish helped, and helped in a cost-effective way.
This study is hardly the last word. It’s not randomized, and some of the metrics strike me as curious. For instance, instead of just measuring the effect of getting a wish granted on one’s number of hospital admissions in the subsequent year, it measures the “likelihood to have fewer unplanned hospital admissions and emergency department visits.”
Instead of directly estimating an effect on hospital admissions, it introduces a binary variable (“has fewer admissions” versus “does not have fewer admissions”) and conducts analysis based on that binary. I’m not a medical researcher, but I’m a pretty avid consumer of social science like this, and that method struck me as odd. Andrew Gelman, a professor of statistics at Columbia who I asked about the study, agreed, telling me, “The practice of discretizing variables is common in medical statistics, and I think it’s generally a bad idea.”
Similarly, the study doesn’t straightforwardly estimate whether the savings from reduced admissions in the treatment group are greater or smaller than the cost of all the wishes. That might just be due to a lack of data, but Make-A-Wish really ought to commission a fully randomized study to see if this finding holds up.
But it does seem plausible to me that the psychological impact of Make-A-Wish could reduce admissions, and that this effect alone could be enough to make up for the cost. If that’s true, it seems to me that it obviates the need for Make-A-Wish as a charity. If it really does save on hospital bills, then it should be in the interest of health insurers to pay directly for Make-A-Wish-style experiences as a way to get their own claims down. For Make-A-Wish, it would be a way to scale the model more broadly.
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