More Isn’t Better In Health Care Spending
Spending on health care varies wildly from one part of the country to another. But there is no relationship between spending and good care.
Grand Junction is also a model of how health care can be delivered both well and (relatively) inexpensively.
Gawande, a doctor writing for The New Yorker magazine, explains that Grand Junction has some of the lowest health care costs in the country. The reason, according to Dr. Gawande, is that doctors in the western Colorado town cooperated. They met regularly about prices and patterns of treatment. When the Colorado doctors found poor practices — too many back operations, for example — they worked to change how medicine in their town was being practiced. The Grand Junction docs created a community-wide electronic records system, sharing notes, tests and treatment histories on patients.
The result: “Problems went down. Quality went up. And costs ended up lower than just about anywhere else in the United States.”
Dr. Gawande’s article is based on a long-running research study of health care costs conducted by doctors at Dartmouth University. Over the past two decades, the Dartmouth researchers have found that health care costs vary markedly from place to place across the United States.
It’s true that some people are sicker than others. Also, some procedures are more expensive in some parts of the country than others. But even when these variables and many more are taken into account, there is still a twofold difference in health care spending per person from from the most expensive region in the United States to the cheapest. Medicare spends twice as much to care for people in New York as it does for people in Hawaii.
(The map at the top of the story shows the variety in average costs per person across the country. The figures come from Medicare. The geography maps hospital regions. The green parts of the country have lower average health care costs; blue areas, have higher costs. There is no rural/urban breakdown.)
Maggie Mahar, at a blog hosted by the Century Foundation, explains why the Dartmouth studies hold up under scrutiny. Mahar says the point of Gawande’s article and the Dartmouth studies is that health care should be paid for not in the volume of services but according to the quality of care.
“This is the heart of the Dartmouth Research, and here there is a consensus,” Mahar wrote. “More care is not better care. Often, it is worse. Spending more is not helping patients. We must squeeze the waste out of the system.”
Kaiser Health News, meanwhile, interviewed several people involved in the health care debate about the Dartmouth studies and the New Yorker article “now being called one of the most influential health care stories in recent memory.”
We have yet to see how these geographical differences play out in terms of rural America. Rural areas constantly cite doctor shortages. Given the Dartmouth findings, however, we have to wonder if there is a similar shortage in care? Also, are rural places perhaps better at producing the kind of cooperative medicine exemplified in Grand Junction? The Dartmouth studies don’t answer these questions.
We do know that geography — especially rural and urban geography — matters. And what these maps and the Dartmouth studies do reveal is that any health care reform needs to account for differences in place. “Geography becomes destiny for Medicare patients,” according to Dartmouth researchers.
What, then, is rural America’s fate?