NCPA - National Center for Policy Analysis

More Care Does Not Equal Better Care

December 1, 2003

More health care is not necessarily better care, say experts. A study of regional variations in Medicare spending found that:

  • In 2000, per capita Medicare spending was $10,550 in Manhattan, for example, but only $4,823 in Portland, Ore.
  • Compared with similar patients in Portland, Medicare enrollees in Manhattan spent more than twice as much time in the hospital and had twice as many doctor visits per year.
  • Despite such a disparity, researchers found that neither the quality of care nor patients' satisfaction with it was related to costs.

The additional services provided in higher spending regions are largely discretionary, like more frequent visits to specialists, longer hospital stays and more frequent use of diagnostic tests and minor procedures. Remarkably, more spending does not lead to more people receiving expensive and proven treatments, like cardiac bypass surgery or hip replacement.

Also, quality and safety were worse in regions where Medicare spending was greatest. Mortality rates were 2 percent to 5 percent higher in regions that spent more. This was not because of differences in the underlying health of the populations in different regions: in every analysis, mortality was no better or worse in the higher spending regions.

This may be due to the fact that almost all interventions involve some risk, and unnecessary tests, treatments and time in the hospital can be harmful. Also, having more doctors involved may make it harder to manage patients' care.

Researchers say that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care -- and may make things worse.

Source: Elliott S. Fisher (Dartmouth University Medical School), "More Medicine Is not Better Medicine," New York Times, December 1, 2003; Elliott S. Fisher et al., "The Implications of Regional Variations in Medicare Spending, Part 1: The Content, Quality, and Accessibility of Care," and "Part 2: Health Outcomes and Satisfaction with Care," February 2003, Annals of Internal Medicine.  

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