Mortality Rates Lower at California Hospitals That Spend More, Study Finds
Greater hospital spending is linked with lower inpatient mortality rates for at least six common medical conditions, according to a recent analysis of more than 2.5 million Medicare hospital admissions in California, HealthLeaders Media reports.
The study, published in the Annals of Internal Medicine, examined spending at 208 California hospitals between 1999 and 2003 and between 2004 and 2008.
John Romley of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California helped lead the study, which analyzed data on patients diagnosed with:
- Acute myocardial infarction;
- Acute stroke;
- Congestive heart failure;
- Gastrointestinal hemorrhage;
- Hip fracture; and
- Pneumonia (Clark, HealthLeaders Media, 2/1).
According to the study, the highest-spending hospitals spent more than three times as much as the lowest-spending hospitals for each of the six conditions.
The study found that higher patient survival was linked with higher spending for each of the diagnoses. For example, patients who received treatment for heart failure at the highest-spending hospitals had a 25% lower chance of dying during their hospital stay than patients who received treatment at the lowest-spending hospitals.
Researchers estimated that if all of the patients treated at the lowest-spending hospitals had instead received treatment at the highest-spending facilities, about 18,000 fewer patients would have died during the first part of the study and about 14,000 fewer patients would have died during the second part of the study (Pittman, Reuters, 1/31).
The report contrasts with previous studies from the Dartmouth Atlas of Healthcare, which found that regions of the U.S. that spend more on medical care generally have similar or worse patient outcomes than regions that spend less on medical care. The Dartmouth research frequently was cited during the development of the federal health reform law.
Possible Contributing Factors
The study does not describe the types of interventions that high-spending hospitals take to achieve lower mortality rates.
Researchers said one possibility is that patients admitted to higher-spending hospitals might be healthier from the outset, possibly because of the hospital's location or its threshold for hospital admissions (HealthLeaders Media, 2/1).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.