We would like to know that we are getting value for our money in health care, particularly in the United States, where we devote so much of our wealth and income to the area. But it seems to be difficult to ascertain whether spending more does lead to better health outcomes. On some gross measures, health care outcomes in aggregate in the United States don’t seem as good as in countries which spend less than we do. And there has been research from some in this country, notably the Dartmouth group, suggesting that higher spending at least sometimes is associated with worse quality. A new study published in the American Journal of Managed Care suggests that in some cases higher spending actually produces better outcomes. (AJMC Article)
The study looked at hospital admissions from 2003 to 2007 to determine an association between hospital spending and inpatient mortality for six major conditions. Spending basically was all spending related to the hospitalization. Factors other spending were assessed for possible causation. And the patients were risk-adjusted (but see our post early this week on the possible flaws for the risk-adjustment method used in this study, although the researchers did their own adjustment to the adjuster to try to account for these flaws), and were not just Medicare patients but were drawn from the entire pool of hospital admissions. Hospitals were divided into five quintiles of spending, ranging from $21,659 to $52,188 per patient during the last two years of life. Patients admitted to the highest spending hospitals had lower risk-adjusted mortality than patients admitted to the lowest spending quintile of hospitals, across all six conditions. This association existed most strongly, however, only in non-teaching hospitals, smaller than average hospitals and nonprofit or public ones. What is unclear from this and other similar studies is what kind of quality of life the patients had, even if they didn’t die in the hospital, what was their life like? Keeping a patient alive to live a few more months in misery is hardly an improvement in quality.