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Health Care Spending

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Guest terry jackon1

Sunday, July 21, 2002 - 12:00 a.m. Pacific

 

Study finds health care spending doesn't correlate with wellness

 

By Gina Kolata

 

NEW YORK ? A growing body of research is leading many medical experts to ask whether more is really better when it comes to health care.

Some medical specialties and geographical areas are suffering from a glut of doctors and hospitals, these experts say. Supply seems to drive demand. More hospitals in an area mean many more days spent in hospitals with no discernible improvements in health. More medical specialists mean many more specialist visits and procedures.

 

"If there are twice as many physicians, patients will come in for twice as many visits," said Dr. John Wennberg of Dartmouth Medical School, where much of the new work is being done.

 

The Dartmouth researchers acknowledge that their findings are unexpected, and some experts say more work is needed to sort out cause from effect.

 

"These relationships are very difficult to disentangle," said Dr. Rodney Hayward, professor of health policy and management at the University of Michigan. Patients in some regions may be demanding more care, either because they are sicker or because they have come to expect it, Hayward said; doctors cluster in areas where there is more demand.

 

Still, Wennberg and his colleagues say the disparities are too stark to be explained entirely by such factors. In a paper published in February in the journal Health Affairs, they wrote that Medicare's typical lifetime spending for a 65-year-old in Miami exceeds spending for a 65-year-old in Minneapolis by more than $50,000.

 

In a further analysis, they found that in Miami, where medical services are particularly abundant, the federal Medicare program pays more than twice as much per person per year as it does in Minneapolis: $7,847 in Miami, $3,663 in Minneapolis.

 

Nor can the gap be explained by regional differences in medical costs, said Dr. Elliott Fisher, an author of the paper who is co-director of the Outcomes Group at the Veterans Affairs Medical Center in White River Junction, Vt., and a professor of medicine at Dartmouth.

 

Older Miamians simply went to doctors and hospitals more often. In their last six months of life, they had more than six times as many visits to medical specialists as those in Minneapolis, spent twice as much time in the hospital and were admitted to intensive-care units more than twice as often.

 

Life expectancy is no greater in regions that have more intensive medical care, the researchers find, and Medicare surveys find that their quality of care is no better.

 

"What increased spending buys you is generally unpleasant interventions like intensive-care units and feeding tubes," Wennberg said.

 

Another recent study, on the distribution of newborn intensive-care specialists and the death rate among infants, reached a similar conclusion. A tripling of the numbers of these specialists did not result in any improvement in infant mortality.

 

The Dartmouth findings are controversial, coming when much of the national conversation is about Americans who are receiving too little care ? not too much ? either because they lack insurance or because they cannot afford prescription drugs.

 

Still, the research is attracting attention from mainstream medical groups, even those who say it is too preliminary to draw firm conclusions.

 

"They are excellent scientists," said Dr. Yank Coble, president of the American Medical Association. But he added that many factors other than supply might be driving demand for medical services, including the cultural preferences in an area and the underlying health of its population.

 

Carmela Coyle, the senior vice president for policy at the American Hospital Association, acknowledged that more doctors and more hospitals led to more care, but asked: "The question is, what level of care is the right level of care? We should ask the questions, have the conversation, but not jump to the conclusion that more is better or less is better."

 

But other doctors not connected with the Dartmouth research say that the body of evidence pointing to overuse is compelling.

 

"If you want to predict the amount of use, all you have to know is the supply," said Dr. Donald M. Berwick, president of the Institute for Healthcare Improvement, a Boston nonprofit group. He says he regards the Dartmouth research as the most important in this area in the past quarter-century.

 

"When all is said and done," Berwick said, "the people who have been most serious about it rarely think we are underresourced. The evidence to my mind is so strong. More is not better, and it often is very, very much worse."

 

 

Copyright ? 2002 The Seattle Times Company

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Hmmm... Interesting statistics, but as for the Miami, Minneapolis comparison, only those who can slug thru snowdrifts remain in Minneapolis after retirement age, or they stay because they can't afford to move to Miami -- and thus would also be more apt to not get medical care unless as a last resort and cut care and treatments shorter.  On the other hand, if the Miami elderly had more $$ for the co-pays, they might say, "sure, why not?  I had better get this checked out and try whatever treatments they recommend."  There are a lot of factors that can scuew the meaning of statistics.  A book I was fascinated by in high school:  How to Lie With Statistics.  [no joke, that's a real book!]  hehe.gif

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