More Does Not Equal Better

The Seattle Post Intelligencer's Cherie Black brings us today's reality check by sharing a recent study from Dartmouth that points to an overabundance of care being a problem in and of itself:

Too much medical care could be harmful to your health.

That's what researchers concluded after examining the nations' hospitals and the care patients receive. Some hospitals and some areas of the country give patients more aggressive care -- meaning more tests, longer hospital stays and more procedures -- than others. And the extra treatment doesn't always translate to longer or better lives.

This brings us firmly back to the issue of our medical system charging per procedure rather than charging for overall results. Billing codes abound, although as we often point out here on the blog, there is not one code for a cure.

The 2008 Dartmouth Atlas of Health Care study, released Thursday, studied more than 4 million Medicare patients at nearly 3,000 hospitals across the country from 2001 through 2005 during the last two years of life.

The patients were 65 years and older and were treated for the top nine leading causes of death, including congestive heart failure, chronic pulmonary disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular disease, diabetes with organ damage and severe chronic liver disease.

Since all of these are chronic conditions, they fall into that segment of health care that produces a vast majority of costs incurred in the United States. When you add in the number of Baby Boomers who are hitting this age bracket, the equation becomes more and more worrisome.

The study found that depending on where patients lived and what hospital they went to, there were big discrepancies in how they were treated.

Researchers reasoned all medical care carries some risk, so the longer a patient is hospitalized and the more procedures and tests performed, the greater the risks, in addition to greater costs.

Costs. It seems to always come full circle back to costs, no matter what angle of the health care discussion you approach. Costs keep people from seeing a doctor until it is unavoidable. Costs keep providers from adding more Medicare patients to their rolls. Costs directly affect who can afford insurance. On that note one tool that is immediately useful came online along with the report:

Launched in conjunction with the Dartmouth study, the online tool at ConsumerReportsHealth.org lets consumers compare treatment approaches among hospitals for the nine serious chronic conditions in the study on a scale from 0 percent to 100 percent (the higher the percentage the more aggressive the treatment).

The percentile rank is based on the total number of hospital days and inpatient physician visits over the last two years of life. Next to each of the nearly 3,000 hospitals, there also are the patient out-of-pocket costs over the last two years of life.

While aggressive treatment is not always a bad thing, in some cases, it is the only correct path. There are far too many cases where it is counterproductive and exists simply due to the perverse nature of financial incentives within the health care industry. Ms. Black's examination of the Dartmouth report provides some interesting and unfortunate new statistics to add to the ongoing discussion.

SOURCE: "More health care may not always be better: Study finds extra treatment can mean extra risks, costs" 05/30/08
photo courtesy of Jeff Kubina, used under its Creative Commons license