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 practice patterns of the lower-cost regions."
The articles are accompanied by editorials by Kenneth Shine, MD, former 10-year president of the Institute of Medicine of the National Academies; Charles Phelps, PhD, provost of the University of Rochester in Rochester, N. Y., and Gail Wilensky, PhD, former administrator of the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services) and more recently chair of the Medicare Payment Advisory Commission and the Physician Payment Review Commission.
ACP-ASIM is the nation's largest medical specialty organization and the second-largest physician group. Its membership includes more than 115,000 internal medicine physicians and medical students. Internists are specialists in the prevention, detection and treatment of illnesses that primarily affect adults.
NOTES TO EDITOR:
Full text of the articles and editorials can be requested by calling 800-523-1546, ext. 2656.
- "The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care"
- Part 2: "Health Outcomes and Satisfaction with Care"
- "Geographical Variations in Medicare Spending," editorial by Kenneth I. Shine, MD, "The Implications of Regional Variations in Medicare--What Does It Mean for Medicare?" editorial by Gail R. Wilensky, PhD
- "What's Enough, What's Too Much?" editorial by Charles E. Phelps, PhD.
To contact Dr. Fisher, call Tamara Steinert (603) 646-1445.
To contact Harold C. Sox, MD, Editor, Annals of Internal Medicine, please call ACP-ASIM Communications Department (215-351-2653).
The Medicare articles are also featured in a video news release, produced by ACP-ASIM. Satellite coordinates are Mon., Feb. 17, 2003, 9:00-9:30 a.m. EST; Telestar 6 Transponder 11 (C) band, and Mon., Feb. 17, 2003, 14:00 –14.30 EST; Telestar 6 Transponder 11 (C) band.
Journal
Annals of Internal Medicine