health-care-spending
Medical Care

More Health Care Spending Doesn't Always Mean Better Outcomes

The old adage “you get what you pay for” doesn’t seem to hold true in health care: Researchers have found that patients who get expensive tests and procedures are just as likely to be readmitted or die as are those who don’t have all that care.

The discovery was made by investigators led by Harvard Medical School and the Harvard T.H. Chan School of Public Health.

The finding, published in JAMA Internal Medicine, is believed to be the first to examine the impact of individual physicians’ spending patterns on patient outcomes.

“If you spend more money on a car or a TV, you tend to get a nicer car or a better TV,” said study senior author Anupam B. Jena, the Ruth L. Newhouse Associate Professor of Health Care Policy at Harvard Medical School. “Our findings show that’s not the case when it comes to medical care. Spending more doesn’t always mean you get better health.”

Research on variation in spending and outcomes between geographic regions and between hospitals has produced mixed results, but most evidence suggests that greater spending does not reliably translate into better outcomes.

What has been missing from the picture, the authors said, is how individual physician spending within the same hospital translates into patient health. That insight, the researchers added, is a key piece of the puzzle because individual doctors make most of the clinical decisions that drive spending and affect outcomes.

“Before now, most of the research and efforts aimed at cutting spending and improving the value of care have been aimed at hospitals, health systems and groups of doctors,” said the lead author Yusuke Tsugawa, a research associate at the Harvard T.H. Chan School of Public Health. “The differences between hospitals and regions are important, but they’re only part of the puzzle. Our findings show how important it is to consider the differences between individual doctors in any effort to improve health care.”

The researchers analyzed outcomes among Medicare fee-for-service patients aged 65 years and older who were hospitalized for a nonelective medical condition and treated by an internist between 2011 and 2014.

Health care spending varied more across individual physicians within a single hospital than across hospitals, even after accounting for differences between hospitals and patient populations, the data showed.

Overall, 8.4 percent of the total variation in health care spending could be explained by differences between individual physicians, compared to 7 percent explained by differences between hospitals.

Next, researchers examined the link between physician spending and patient outcomes.

When they compared lower- and higher-spending physicians, the researchers found no difference in 30-day patient mortality, nor did they see a difference in readmissions, two factors regarded as key measures of quality of care.