Editor's Note: This article continues our 8-part series excerpted from the "Healthcare Hostage Crisis" chapter of AC360° contributor David Gewirtz's upcoming book, How To Save Jobs, which will be available in October. To learn more about the book, follow David on Twitter at http://www.twitter.com/DavidGewirtz. Last week we looked at how much this all costs. This week, we'll start looking whether the extra money we spend is getting us better care.
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David Gewirtz | BIO
Editor-in-Chief, ZATZ Publishing
Since America spends far more on health care than any other country, it stands to reason we should be healthier here than people are anywhere else in the world. But are we? Is our health care system working so well, it's worth the vastly greater cost?
One way to answer that is to look at spending variations within the United States. The Geographic Variation in Health Care Spending report released in February 2008 by the Congressional Budget Office compared health care spending across the country. Here's what they concluded about the quality of more expensive health care:
Areas with higher-than-expected Medicare spending per beneficiary tend to score no better and, in some cases, score worse than other areas do on process-based measures of quality and on some measures of health outcomes.
Patterns of treatment in high-spending areas tend to be more intensive than in low-spending areas. That is, in high-spending areas a broader array of patients will receive costly treatments. Those treatment patterns appear to improve health outcomes for some types of patients, but worsen outcomes for others.
Another study, published in the April 2004 issue of the Health Affairs policy journal, reinforced the counter-intuitive observation that higher cost doesn't necessarily yield higher quality. Researchers Katherine Baicker and Amitabh Chandra found:
If spending per Medicare beneficiary increased by $1,000 in a state, there was an associated decrease in most measures of "good" medical practice, including, for example, the share of heart attack patients who were given aspirin (a 3.6 percentage point decrease) or offered advice about smoking cessation (6.8 percentage points) at discharge, the share of pneumonia patients who received antibiotics within 8 hours of arrival at the hospital (2.0 percentage points), and the share of diabetes patients whose blood sugar concentrations were evaluated (3.2 percentage points).
Three years later, in 2007, researcher Chandra paired up with Douglas Staiger. Their article, "Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks" in the Journal of Political Economy looked at how heart attacks were treated in high-spending areas vs. lower-spending areas.
Among heart attack patients, there are usually two approaches: a high-cost surgical treatment and a far lower-cost medical management treatment (diet, exercise, etc). According to Chandra and Staiger, if a patient that truly needed surgical intervention lived in a high-spending area, he or she would usually fare better.
But, if a patient that really didn't need high-cost intervention lived in a higher-spending area, he or she would likely fare considerably worse over the long haul, either through poorer medical management treatment or pressure to undertake higher-cost and possibly unnecessary surgical interventions.
Of course, this research applied more to Medicare spending than for non-Medicare spending, and it doesn't reflect quality of care in the high-spending United States as compared to, say, the United Kingdom or Canada.
It's extremely hard to make these comparisons. For example, if we live shorter lives here in America, but eat nothing but Big Macs, is that the fault of poor medical care, or simply poor life choices? Although there have been many studies on comparative effectiveness, none are universally accepted. Worse, many of the studies have been funded by industry groups with billions and even trillions of dollars at stake, so the conclusions would naturally tend to lean in favor of the vested interest.
But we can look at a few factors and draw some rudimentary conclusions. For example, we can compare infant mortality rates and life expectancy rates among various countries and derive some interesting information.
And that's what we'll do next: we'll see how our health care compares to both India and China - and to Canada and the U.K. The results are demoralizing, at best.
Follow David on Twitter at http://www.Twitter.com/DavidGewirtz.
Editor’s note: David Gewirtz is Editor-in-Chief, ZATZ Magazines, including OutlookPower Magazine. He is a leading Presidential scholar specializing in White House email. He is a member of FBI InfraGard, the Cyberterrorism Advisor for the International Association for Counterterrorism & Security Professionals, a columnist for The Journal of Counterterrorism and Homeland Security, and has been a guest commentator for the Nieman Watchdog of the Nieman Foundation for Journalism at Harvard University. He is a faculty member at the University of California, Berkeley extension, a recipient of the Sigma Xi Research Award in Engineering and was a candidate for the 2008 Pulitzer Prize in Letters.
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