Higher Medicare Spending Does Not Mean Higher Quality, Study Finds
States that spend more on Medicare do not necessarily provide better quality of care to beneficiaries, according to a study published Wednesday on the Health Affairs Web site, the AP/Boston Globe reports (AP/Boston Globe, 4/7). The study, by Katherine Baicker and Amitabh Chandra, both assistant professors of economics at Dartmouth College, examined Medicare data from the late 1990s and 2000 (Fahey, Manchester Union Leader, 4/7). They focused on 24 basic treatments, including administration of beta blockers for heart attack patients, antibiotics for pneumonia patients, mammograms for women and eye exams for diabetics. Researchers found that the states that had lower Medicare spending used such treatments the most, while the states with the highest Medicare spending tended to use the money on more expensive intensive care, according to the AP/Globe (AP/Boston Globe, 4/7). New Hampshire, which had the highest overall quality ranking, had the lowest Medicare spending at $4,863 per beneficiary, while Louisiana, which had the lowest quality ranking, had the highest spending at $8,238 per beneficiary (Lipman, Palm Beach Post, 4/7). States with higher Medicare spending also tended to have a greater concentration of specialists, while states that spent less and provided a higher quality of care tended to have more general practitioners. Baicker said the discrepancy might be attributable to the fact that specialists concentrate on "sophisticated testing, letting the more basic and effective treatments fall through the cracks," according to the AP/Globe. She added that specialists might spend more time treating a specific acute condition, instead of concentrating on a patient's overall health. The study also found that Medicare beneficiaries in states with higher spending had longer hospital stays and were more likely to be admitted into intensive care in the last six months of life (AP/Boston Globe, 4/7).
The report states that "[e]ncouraging greater access to general practitioners or involving specialists in the provision of effective care could improve the overall quality of care received by elderly Americans" (Manchester Union Leader, 4/7). "Improving quality of care has everything to do with how the money is spent. We need to determine how to make better use of health care dollars, especially with the baby boom generation about to enter the Medicare system in the next few years," Chandra said (AP/Boston Globe, 4/7). Baicker added, "I wouldn't say that if we spend less we'd have higher quality of care or that we're spending too much. What I would say is that the money we're spending could be used better" (Heldt Powell, Boston Herald, 4/7). The study is available online.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.