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Medicine Science

Does Higher Health Care Spending Lead To Better Patient Outcomes? 504

First time accepted submitter ericjones12398 writes "If you haven't seen the words 'health care' in news headlines lately, you must be living under a rock. What seems most controversial among the latest research and news is a flawed payment scale that undervalues primary care and overvalues specialty care. There is evidence suggesting that publicly funded health care spending (i.e., Medicare) has not been based on primary health care needs. Rather, In the U.S. Medicare spending relies on a resource-based relative value scale (RBRVS) which seems to promote higher spending without evidence of better patient outcomes. A study comparing spending and mortality rates in Ontario had the opposite findings however, supporting a link between higher spending and better outcomes for patients. What are we doing different in the U.S.? "
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Does Higher Health Care Spending Lead To Better Patient Outcomes?

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  • by BenLeeImp ( 1347831 ) on Monday April 02, 2012 @12:50PM (#39550209)

    Food-safe plastics do exist. I cannot say whether this particular plastic used was food-safe or not, but its at least possible.

  • by sycodon ( 149926 ) on Monday April 02, 2012 @12:57PM (#39550339)

    After the Supremes ditch that abortion of a Bill, Obamacare, there needs to be a top to bottom evaluation of the entire medical system.

    Fundamental assumptions about the value of a service and the person providing that service need to be challenged. The infrastructure of record keeping, ownership, and payment needs to be overhauled. Information about services and their costs need to be plain and transparent because if any market is to function correctly, all the players need to know all the facts up front.

  • Re:We all know why (Score:5, Informative)

    by jjohnson ( 62583 ) on Monday April 02, 2012 @01:06PM (#39550467) Homepage

    And when you don't directly have to pay for it (ie Medicare) then you don't care about the cost to benefit.

    This isn't true in UHC countries like Canada or France or Sweden, so why would it be true in the U.S.? In UHC countries, annual per capita spending is around 55% of what it is in the U.S. (in 2010, $3,900 to $7,400), and they have better aggregate outcomes as measured by things like life expectancy (average 2+ years higher in UHC countries than in the U.S.). With UHC schemes, it looks pretty clearly like they pay less and get more effective medical treatment.

  • by alexander_686 ( 957440 ) on Monday April 02, 2012 @01:19PM (#39550665) []

    This is something of a counterpoint. Amanda Bennett wrote an article about her husband's death. He had cancer and was expected to live a year or 2 more. Aggressive, and expense, treatment, meant that he live for 7 more - some of them good - some of them bad. So he beat the odds and thus can be considered a success. On the other hand, Bennett tries to weigh the cost of treatment, quality of life, and how the health care system should be structured. She does not come to concise answer, but she writes very well about the struggle.

  • by Sycraft-fu ( 314770 ) on Monday April 02, 2012 @01:20PM (#39550683)

    That's what is happening with my grandma, unfortunately. Probably Alzheimer's in her case. Whatever the case, her mind is almost gone. She requires a full time care taker at home now, and before long will need to move to a complete managed care facility. Fortunately she's got the money, it is no problem. However it is going to cost a boatload of money, particularly since other than that she's in pretty good health for a 85 year old. She could live 5 more years (maybe more).

    So what do you do in cases like that? I mean the perfect answer is to find a cure for dementia but it isn't like we can just snap our fingers. For now we have to deal with it. The only cheap solution is basically to just ignore people with it and let them die a horrible death. If you want to be civilized about it you have to care for them and it is damn expensive.

    These are new problems on the scale we face now. People didn't used to live long enough on average for this to happen a lot. Now, instead of just dying fairly quick, many people have a downward slide that can last a long time. That is damn expensive and not a situation where yo can "Just pull the plug," unless by that you mean "Ignore the person and let them die of starvation."

  • Re:We all know why (Score:5, Informative)

    by jjohnson ( 62583 ) on Monday April 02, 2012 @01:26PM (#39550765) Homepage

    Because across a whole population, you would expect that the sum total of benefits of things like exercise, good medical care, healthy lifestyle choices, etc. would show up in life expectancy. When you have two populations, like Canada and the U.S., who have pretty comparable lifestyles overall, it seems like a reasonable, if blunt, proxy for the overall quality of health care.

    In the case of Canada and the U.S. at least, more on-point aggregate measures show the same thing: Canadians as a whole get better health care than Americans, and seem to have less trouble making appropriate cost/benefit tradeoffs in their health care.

  • by Anonymous Coward on Monday April 02, 2012 @01:41PM (#39550957)

    The difference these days is dementia. I can speak from experience that it is far easier to care for a terminally ill family member without any mental incapacity than with. With people living longer, there is far greater rate of dementia among our old and ill. And to watch someone you have known and loved fade away from you is heartbreaking.

    On a more selfish level, just having someone show appreciation for your care is also very important, and caring for someone that doesn't know you any more can be hard.

  • Re:We all know why (Score:5, Informative)

    by CptPicard ( 680154 ) on Monday April 02, 2012 @02:14PM (#39551413)

    Well, I'm a Finn, so we count as a "Socialist medicine" country, and as a somewhat severely disabled person by birth who still has been patched up to be a happy taxpayer, I certainly count as a huge and probably never fully profitable beneficiary of our system, but anyway...

    I frankly do not believe in the "UHC people do not care about the cost to benefit" argument. At least in civilized countries, people will have some common sense that even when they might totally destroy their health, it's not going to be fun even though they might get healthcare in the end. You'll want to avoid getting an organ transplant in general even though it might be paid for. When there are obvious public health concerns, such as the generally excessive alcohol intake in Finland, educating the public is a relatively small "totalitarian" cost as the objective benefit is so easy to see. Pure Libertarians will of course always disagree, and I can appreciate that.

    The benefit of general social insurance not only in economic but ethical terms just outweighs any abuse concerns. Those who would, really deserve the pain that comes with the unfortunately necessary pain that comes with the condition they put themselves into, regardless of the healthcare they're getting.

    And when it comes to actually *how* to provide the healthcare, it's all actually mercifully objective -- it's not like buying a car. Medicine is a science. We know that certain treatments work, in a scientific sense, and others do not. Hospitals do not need to be hotels. During my lifetime, I've been treated by incredibly skilled and compassionate public-sector doctors and nurses who have done their best -- and yet I've always been glad to be out of the hospital, as that means I'm getting better. And the outcome has been pretty good so far, yet I'm not so sure after all the cuts that are being imposed at the moment. Even the public sector can't run on thin air :-)

  • Re:Hold on a second (Score:2, Informative)

    by DavidTC ( 10147 ) <<moc.xobreven> ... .vidavsxd54sals>> on Monday April 02, 2012 @02:44PM (#39551733) Homepage

    That was one of the stupidest posts I've ever read.

    Firstly, I will start by saying your point about subsidies raising the cost of colleges is probably entirely right. It does, indeed, work that way, and part of the high cost is due to government subsidies. (Which is a problem that is very solvable.) Another part is, for quite some time, employment has been a 'buyers market', with businesses thinking of increasingly idiotic ways to filter applicants, and college was the first filter added. Thus adding (pointless) demand, and thus raising prices. (Which is something I'm not sure how to solve.)

    However, the rest of your post is extremely stupid, because the government subsides neither health care nor housing.

    There is no government entity paying part of the cost of housing to any large amount, and in the very few circumstances such a system existed, it exists to cover rent, and had nothing to do with purchase of housing.

    If you want to blame government subsidies of low-income apartments for raising the rents of such apartments, feel free, but that had fuck-all to do with the bubble, which happened because banks were (pretending to) subsides the housing market via loans. (Which they were doing because they were playing a complicated game by trading the loans.)

    I.e, the increase in price in the housing market was, indeed, completely due to the fact that people were not paying full price for their house, or rather that banks no longer cared if people could pay for their house in the long term. That free money or rather the perceived free money, did indeed make housing prices go up...but didn't have anything whatsoever to do with the government.

    Saying 'The government covering a few hundred dollars rent for the crappy apartments of a hundred poor people caused $400,000 a house subdivision houses to be built nearby.' is completely nonsensical. I'm pretty sure this is some of the 'The government caused it all by the CRA' bullshit that idiots cite, except you appear to have failed to notice the CRA didn't subside anything at all.

    As for health care, I can't even figure out what you mean. The government is selling insurance, just like the private market .What's more, it's insurance for people who the insurance companies are not competing over in the first place. (The poor cannot afford private insurance anyway, and the insurance companies sure as hell don't want to insure people over 60, which was the entire reason Medicare was created in the first place.) The government is, in no way, subsidizing anyone's insurance. There is no insurance out there that costs $500 a month and the government chipping in another $400. Such a thing does not exist in any manner.

    Now, under the new law, poor people will, indeed, have their required insurance subsided...but unless there have been some recent developments in time travel I'm unaware of, this seems unlike to have caused problems before it starts.

  • Re:We all know why (Score:5, Informative)

    by Dixie_Flatline ( 5077 ) <> on Monday April 02, 2012 @03:17PM (#39552085) Homepage

    The question here is whether those two things are mutually exclusive. Frankly, we can see from the example of our two countries that they're not. Rich people in Canada live with a de facto two-tier system. They have most of their care paid for through their taxes. Effective primary care means that they--and everyone else--prevent a substantial amount of sickness. This is good for society on the whole. While I don't have hard data to back that up exactly, it seems to follow: a society where people are sick is going to have a reduced capacity to work.

    One of the biggest problem in the US is the money spent on paperwork. Study after study has shown that having the insurance middleman screwing things up is no small part of the additional costs. That's how the US can spend more money per capita by almost a factor of two and still get no better outcomes. Canada's single-payer system reduces the drag inherent in providers fighting with insurers over how much to pay.

    Canada's health system, it should be noted, only covers a list of 'essential' services, so we also live in a mildly two-tier system. Laser eye surgery isn't covered by the state, and only partially covered by insurance (yes, you can buy private insurance here, too!) Unsurprisingly, the price of lasik continues to go down. But again, it's deemed non-essential, and that's probably true.

    Moreover, you CAN, if you like, open a private, for-profit heart surgery clinic in Canada. You just can't bill the Canadian government for it. Private citizens would have to field the full cost of the surgery, with no medicare payments to defray the cost. But nobody does that here because the market simply doesn't have enough people in it to support that. Hence the tourist surgery.

  • Re:We all know why (Score:2, Informative)

    by anyGould ( 1295481 ) on Monday April 02, 2012 @03:17PM (#39552095)

    Hate to break it to you, but Canada's "healthcare crisis" is 80% fabrication by our Republican/Tea Party equivalents.

    Think about it - our system is taxpayer funded. So healthcare can't go broke, unless the entire *country* goes broke. (Even the deficit is largely self-inflicted - if Harper hadn't cut the GST we'd still be in happy surplus land.

    Now, it is true that healthcare costs are rising - but that's largely a function of the government being beholden to medical lobbies rather than negotiating for better drug rates.

  • Re:We all know why (Score:5, Informative)

    by Ihmhi ( 1206036 ) <> on Monday April 02, 2012 @04:45PM (#39553183)

    Yeah, let's use something a bit better like the Infant Mortality Rate: []

    4. Sweden 3.18/1000 births
    9. France 4.10/1000 births
    24. Canada 5.30/1000 births
    34. United States 7.07/1000 births
    Data is the average of the last 15 years. See the link above for more.

    But socialized medicine is bad and for commie Reds!

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