Medical Care, More May Not Always Mean Better
November 19, 2003
In a recent study appearing in the New England Journal of Medicine, researchers have found that a decrease in hospital services provided by the Department of Veteran's Affairs (VA) did not lead to a decrease in survival rates.
The researchers tracked hospital visits for 342,300 beneficiaries in nine disease cohorts with serious chronic diseases. They found:
- From 1994 through 1998, VA bed-day rates fell by 50 percent, rates of medical-clinic visits and visits for testing and consultation increased moderately, and rates of urgent care visits fell by 35 percent.
- The decline in hospital use did not curtail access to needed services and was not associated with serious consequences for chronically ill VA beneficiaries; survival rates remained essentially unchanged over the study period.
- Current incentives must change, since they contribute to the overuse of discretionary services.
- Patients need much better information on the risks, benefits and uncertainties of specific interventions and on the actual quality of their providers.
- The contributions of the local supply of hospital beds and the composition of the medical workforce to both spending and quality need to be addressed.
Fisher indicates that this study is in line with other research that has found that high intensity use of services is associated with lower quality of care and worse outcomes than a more conservative practice pattern.
Source: Carol Ashton et al, "Hospital Use and Survival among Veterans Affairs Beneficiaries, New England Journal of Medicine, October 23, 2003 and Elliott Fisher, "Medical Care - Is More Always Better?" New England Journal of Medicine, October 23, 2003.
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