NCPA - National Center for Policy Analysis


December 19, 2006

There is mounting evidence that the zeal to treat and spend by doctors and hospitals may actually hurt patients.  Even for diseases for which the appropriate treatment is widely accepted, doctors across the country take vastly different approaches, often leading to enormous expense without making any appreciable improvement in their patient's health, says Eduardo Porter in the New York Times.

Consider chronically ill elderly patients in the last two years of their lives.  According to a comparison of hospitals across the country done by researchers at Dartmouth College:

  • In New York State, the average cost of those two years would be $38,369.
  • In Florida, by contrast it would be $29,604.
  • In Iowa, it would be only $23,746.

Overall, another Dartmouth study found that from 1986 to 2002, regions that were spending the fastest also had some of the worst practices, in terms of providing tried-and-true therapies, and recorded the smallest gains in survival rates.

But perhaps the most puzzling inefficiency in how doctors treat disease is not the spending on fancy yet ineffective therapies; it's the lack of spending on treatments that have been known to work for years.  Take heart attacks, for example:

  • A study found that growing aspirin use explained more than a third of the decrease in the death rates of heart attack victims from 1975 to 1995.
  • Yet another study found that from 1995 to 2002, only 83 percent of patients with coronary artery disease took aspirin, and only 71 percent did so consistently.

Financial incentives in the health care system are part of the problem, experts say.  These incentives encourage hospitals and clinics to provide more services, hire more specialists and install more devices.  The result is patients are shuttled from one specialist to the other, with none taking the responsibility for providing a simple but effective remedy.

Source: Eduardo Porter, "The More You Pay, the Better the Care? Think Twice," New York Times, December 17, 2006.

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