Increased Spending Does Not Improve Health Care Quality
Several studies "suggest there is no relationship" between health spending and outcome of the care, including a February study that found hospitals with the largest growth in spending from 1986 through 2002 "had some of the worst practices, in terms of providing tried-and-true therapies," and some of the "smallest gains in survival rates," the New York Times reports.
In that study, researchers from Dartmouth Medical School found that Medicare spending on hospital care for people who had heart attacks increased by two-thirds from 1986 through 1996, after adjusting for inflation. During that time period, the percentage of heart attack patients who were alive one year later increased by 10 percentage points to about 68%, the study found.
Between 1996 and 2002, however, Medicare spending on treatments for people who had heart attacks increased by about 14% after inflation, but there was no improvement in survival rates, the study found.
According to the Times, the current health care system is partly responsible for the rise in spending and limited quality improvements because it "encourages aggressive treatment" and "stimulate[s] health spending that provides little benefit to patients."
Hospitals and physicians are encouraged by the health system to use expensive treatments for the most financial gain and to hire specialists, which fragments and detracts from comprehensive patient care, the Times reports. The Times adds that "the most puzzling inefficiencies" might be "the lack of spending on treatments" for conditions like heart disease "that have been known to work for years, like beta blockers."
Congress "has taken a step" in improving medical practices by approving legislation that would provide Medicare bonuses to physicians who report certain quality of care data and follow certain guidelines for care, but "changing entrenched practices is not easy," according to the Times.
Many physicians criticized the legislation, but some experts "contend that this form of accountability is a necessary step to deal with inefficiencies that riddle the health care system and fuel much unnecessary spending on care," the Times reports (Porter, New York Times, 12/17).