Monday, April 07, 2008

The Path to the Right Kind of Health Care Reform

An important new study by the Center for the Evaluative Clinical Sciences of the Dartmouth Medical School shows that treatment for terminally ill Medicare patients varies widely based on geographic location and individual hospitals. Patients receiving more expensive care utilizing more services did NOT have better outcomes than those that received fewer services at a lower cost.

Differences in cost were almost entirely attributable to higher utilization of services, not differences in fees for service.

If patients across the country had received care consistent with practice patterns in lower cost areas, it would have resulted in savings of up to $40 billion.

While numerous reports on this study are appearing in newspapers today, the best account I have seen is in the Senior Journal. According to that report:

The care of people with chronic illness accounts for more than 75 percent of all U.S. health care expenditures, indicating that overuse and overspending is not just a Medicare problem - the health care system as a whole has not developed efficient, effective ways of caring for people with severe chronic illnesses.

The study paints a picture of the health care system in disarray over the treatment of chronic illness. There are no recognized evidence-based guidelines for when to hospitalize, admit to intensive care, refer to medical specialists or, for most conditions, when to order diagnostic or imaging tests, for patients at given stages of a chronic illness.

As that account states, these problems are not unique to the Medicare system. I have seen studies of workers' compensation patients showing similar, enormous variations in utilization of services in different geographic areas.


Blogger Lanette said...

It's a good study that will hopefully lead to better healthcare and fiscal management, but there are issues the article did not address. The chronically ill patients that are non-compliant with their treatments and medications need acute management more often than those who are compliant. And common sense dictates that those who carefully follow their medication and diet regimes will fare better than those who don't.

I understand the point in the article and in your blog. Obviously, patient compliance cannot be regulated, but over expenditure and standardization of medical care can.

3:10 PM  

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