A comprehensive analysis finds that Medicare enrollees in regions receiving more care do not have better access to or a higher quality of care, nor do they have better survival or higher satisfaction with care.
The analysis and three accompanying editorials are published in the Feb. 18, 2003, issue of Annals of Internal Medicine, published by the American College of Physicians-American Society of Internal Medicine.
Researchers from the VA Outcomes Group in White River Junction, Vt., and Dartmouth Medical School, Hanover, N.H., studied four groups of Medicare enrollees: patients with heart attacks, colorectal cancer, hip fracture, and a representative sample of the elderly. In each group, patients living in highest-spending regions received about 60 percent more care than those in lowest-spending regions, even though their needs for care were nearly identical.
"The additional care was largely devoted to greater use of the hospital, diagnostic tests, and referrals to specialists," said Elliott S. Fisher, MD, MPH, professor of medicine at Dartmouth Medical School and the lead researcher.
"This study provides strong evidence that more medical care does not necessarily result in better medical care," Fisher said.
Those in higher-spending regions were actually less likely to receive certain preventive services, such as influenza and pneumococcal immunizations and Pap tests.
"Our study shows quite clearly that perhaps 30 percent of medical care is devoted to services that do not necessarily improve health outcomes or the quality of care," said Fisher. "It suggests that care in the United States could be just as good and cost less if higher-spending regions adopted the more conservative
Contact: Susan Anderson
American College of Physicians