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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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  • We all know why (Score:5, Insightful)

    by oldhack ( 1037484 ) on Monday April 02, 2012 @12:37PM (#39550025)
    We have a medical-industrial complex. Money's gotta flow.
  • by Anonymous Coward on Monday April 02, 2012 @12:39PM (#39550051)

    all goes to someone's profit, not someone's care.

  • No (Score:5, Insightful)

    by Cigarra ( 652458 ) on Monday April 02, 2012 @12:41PM (#39550085)
    The answer is no [wikipedia.org]. Next question?
  • by repapetilto ( 1219852 ) on Monday April 02, 2012 @12:42PM (#39550095)

    5% of the population (15 million people) account for 50% ($1 trillion) in spending.

    http://www.ahrq.gov/research/ria19/expendria.htm [ahrq.gov]

  • by thechemic ( 1329333 ) on Monday April 02, 2012 @12:50PM (#39550231)
    The United States runs a "for profit" model. Canada runs a "for better society" model. In one model the fundamental design of one system dictates that consumers spend as much as possible and receive as little as possible. The fundamentals of the other design dictate that consumers all receive adequate care, and the only reason to spend more is to get more.
  • by ColdWetDog ( 752185 ) on Monday April 02, 2012 @12:51PM (#39550241) Homepage

    Hi grub! You're back! We missed you!

    Unfortunately, this time you're more correct than insane. (We won't talk about the adjustments - those should be done with a framing hammer for most people).

    The little article quoted to support the argument that 'more spending is better healthcare' is illustrative.

    mortality rate was 12.7% vs 12.8% for AMI, 10.2% vs 12.4% for CHF, 7.7% vs 9.7% for hip fracture, and 3.3% vs 3.9% for CHF

    Note those big differences folks. Right down there in the noise floor.

    In the US we spend WAY too much doing things to people that gives very little benefit to them. The major culprit is the 'free market' system where profit (at multiple levels) is considered the appropriate metric. Although everyone and their little sister will go on about how 'patient care is first', everyone in the system realizes that this is just a sop to the weak of mind.

    It's been an interesting experiment, but the results are all too clear. Going to be a bit longer before the folks who stand to benefit from this mess get forced to clean it up (just like a couple of other industries, isn't it?).

  • by Dr_Barnowl ( 709838 ) on Monday April 02, 2012 @12:51PM (#39550243)

    Yes, but if there is a profit, it's not going to care for someone, it's lining someone's pocket.

    Plus the mechanism you use to gather the profit is horrendously inefficient - for that 15% margin you are essentially doubling your costs by paying for all the insurance bureaucracy on one side and the bureaucracy on the healthcare side designed to interface with it.

    The USA pays double per capita what it's next nearest neighbour among the G8 nations spends on healthcare, for comparable outcomes.

  • by ThePhilips ( 752041 ) on Monday April 02, 2012 @12:54PM (#39550285) Homepage Journal
    The profit comes from getting paid more while providing less care, or even better - no care at all.
  • Americanitis (Score:4, Insightful)

    by girlintraining ( 1395911 ) on Monday April 02, 2012 @12:55PM (#39550299)

    What are we doing different in the U.S.?

    We're throwing our money at CEOs the same way school girls throw wet panties at Justin Bieber at concerts. Next question.

  • Re:Obesity (Score:4, Insightful)

    by Anonymous Coward on Monday April 02, 2012 @12:57PM (#39550331)

    What if spending money isn't the answer? What if the answer deals more with a change in social values?

    Do you know how you change social values, especially regarding health? You spend money on health programs and preventative care. If people only go to the doctor when they have a serious illness, then only serious illness will be treated and preventative care will be ignored. Make care free or close to it then spend on getting people to care about health. It will save money in the long run.

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

    by englishknnigits ( 1568303 ) on Monday April 02, 2012 @12:58PM (#39550345)
    And when you don't directly have to pay for it (ie Medicare) then you don't care about the cost to benefit. This is why most people should really be on something along the lines of an HDHP and treat health insurance as insurance. When you spend your money on yourself you care about both the cost and the benefit. When you spend someone elses money on someone else (ie government spending) you have no incentive to care about cost or benefit.
  • by UnknowingFool ( 672806 ) on Monday April 02, 2012 @01:07PM (#39550481)

    One of the areas where the US needs more focus is end-of-life care. More often than not, individuals and their families are opting for expensive treatments at the end that may cause suffering and not provide any benefits for a tiny chance at a cure. One of the twists of advances in medicine is that people can be kept alive despite major medical problems, but many would not consider being kept alive in that state as "living" especially when no cure is likely.

    This was the background of the infamous "death panels" fiasco at the beginning of the health care reform debate. Under Medicare rules, doctors can only bill for their time for certain things. Discussing end-of-life options was not eligible. So doctors had to (1) not bill, (2) lie about their time, or (3) not discuss the options at all. The proposed change was made so that it would encourage doctors to have these discussions with patients that would reduce costs and suffering. But the Republicans twisted it into some sort of tribunal where people would have to advocate for their lives.

    For a more reasoned look at the problem watch this Frontline [pbs.org] about end-of-life care today and the issues surrounding it. The one perspective from the doctors is complex as they all want to save their patients but they question whether some of their treatments cause their patients more suffering more than anything else.

  • Hold on a second (Score:4, Insightful)

    by geoffrobinson ( 109879 ) on Monday April 02, 2012 @01:09PM (#39550503) Homepage

    What do health care costs, housing costs (pre-bubble bursting), and college tuition costs all have in common?

    1) They all have risen much faster than inflation.
    2) They are all subsidized by government.

    If you hide the cost of a good from people via the tax code and you subsidize the good, you will get no mechanism to control costs. The tax code hides the cost of insurance since employees don't see or feel the employer's payment.

    Oddly enough Lasik surgeries haven't gone up in price. It isn't covered by insurance.

    Granted, there's a lot more nuance and information to bear on this topic. But it is a dynamic that can't be ignored. If you hide the price from someone, costs will go up. Unless you want to ration. Which when the HMOs tried to do it in the 1990s was about as popular as a skunk crashing a party.

  • Re:Obesity (Score:5, Insightful)

    by ColdWetDog ( 752185 ) on Monday April 02, 2012 @01:11PM (#39550529) Homepage

    75% of money spent on health care in the U.S. is for self-inflicted diseases or the consequences thereof. That might be a good place to start looking.

    I'm not saying that people that need dialysis or bypass surgery shouldn't be helped; I'm saying we should be spending money on ways to help them not get there in the first place.

    Citation please. Those are numbers pulled out of various nether regions. Yes, people can do much for themselves to decrease / delay morbidity (not mortality so much). And yes, we should encourage and teach people to watch their weight, not smoke, drink alcohol in vast moderation, do yoga, clean their rooms and brush their teeth twice daily (floss once) but health care still is going to cost quite a bit of money - maybe more as the number of frail elderly that need increasing care climbs dramatically.

    Remember, one entertaining factoid in all of this - with all the 'bad things' we're doing (pollution / plastics / obesity / diabetes / whatever disease is popular this month) the average longevity of the population is slowly and steadily INCREASING. Now most of us think that's a good thing. Not many want to go back to the pre medical days of a 35 year average longevity, but it does have it's consequences....

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

    by vlm ( 69642 ) on Monday April 02, 2012 @01:13PM (#39550555)

    When you spend someone elses money on someone else ... you have no incentive to care about cost or benefit.

    Ah but we're talking about medical care here, and only a microscopic minority of freaks enjoy pain.

    As a thought experiment, put out a sign offering "free" root canals. Yes, yes for about a week you'll get a huge backlog of uninsured people with horrific dental pain who could not get any care before and now will joyously sign up for your free root canal. Once you work thru the backlog, the only people voluntarily going to your free-root-canal office are the same tiny fraction of people who really need one, and a couple of freaks with whip lashes and rope burns all other their bodies who do it for the pain. The price of a root canal seems to have very little correlation with the desire of the population for a root canal.

    I'm thinking the market for prostate exams, mammograms, broken bone casts is kind of the same.

    It's a completely different market from offering, say, free "adult" non-therapeutic massages, or free pr0n pixs, or free movies/music/tv, or addictive drugs, where demand is basically infinite.

    Lets say you offered "free" atmospheric oxygen. Well, first I'd breathe deeply, for free, just because I can, but that would get boring real fast. Then I'd probably have a few bonfires in my backyard, since oxygen is free so why the heck not. Hell I'd probably get a pet cat that breathes "free" oxygen. But extremely rapidly the demand kinda levels off. I had "free" water and "free" heat at my bachelor pad apartment years ago, and there is no fundamental reason to waste it, so I didn't. How much water do you think I can drink per day, anyway?

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

    by superdave80 ( 1226592 ) on Monday April 02, 2012 @01:13PM (#39550563)

    ...as measured by things like life expectancy...

    I've never understood why this gets thrown around as a measure of the quality of health care received, when there are tons of other factors that have much more of an affect on this (exercise, smoking, eating right, etc.).

  • by Anonymous Coward on Monday April 02, 2012 @01:17PM (#39550633)

    The biggest giveaway for me is that in most places in the US, medicine uses the Caduceus (commerce, trickery, and death) as its symbol; in the majority of the world, medicine uses the Rod of Aesculapius (healing and health) as its symbol.

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

    by DrgnDancer ( 137700 ) on Monday April 02, 2012 @01:19PM (#39550661) Homepage

    That doesn't track. As the article points out, places with true "socialized" medicine (Canada and Europe) typically don't have these problems or have them in lesser degrees. When there's no profit motive, there's less incentive to over-test, less incentive to push unnecessary pills or treatments, and less over specialization. The problem with Medicare isn't that it causes people to overspend because they don't see the pain of the spending (medicare still requires copays and such), it's the system into which it's been pushed.

    Doctors and insurance companies have an adversarial relationship that drives cost up so both of them can profit. Enter Medicare. It has to play the game by the rules established by private insurance and doctors. It inherits the waste in system and (being government) adds some of its own. The problem isn't that people are wasteful of things they don't pay for (some are or course, but the national health care systems of numerous countries attest that it's not all of them, nor even an unworkable number of them). It's that the profit motive of both doctors and insurers keeps driving up costs, and Medicare has to live in their world. If socialized medicine is inherently more expensive, why do we pay so much more per capita for health care than any other rich country, but achieve, at best, comparable results?

  • by Moses48 ( 1849872 ) on Monday April 02, 2012 @01:24PM (#39550737)

    1) Mortality rate != quality of life. My "health care" is about the latter, while the former also plays a role.
    2) Insurance Scheme != Free Market. If you went to an old lady and said you can either have the $90,000 that a hip replacement costs, or you can get the replacement, THAT is free market. People would be more diligent about the VALUE of their treatment. Can $90K buy more quality of life than the replacement? I suppose that depends on the situation, but at least the person getting the treatment could actually have "informed consent"!

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

    by Spad ( 470073 ) <slashdot.spad@co@uk> on Monday April 02, 2012 @01:29PM (#39550791) Homepage

    Just because the US healthcare system can offer a very high quality of care doesn't mean that it's any use to its citizens when the vast majority of them can't afford it.

    If you're fabulously wealthy then the US offers some of the best healthcare in the world, but if you're not, it's a disaster area.

  • by Artraze ( 600366 ) on Monday April 02, 2012 @01:34PM (#39550867)

    > In the US we spend WAY too much doing things to people that gives very little benefit to them. The major
    > culprit is the 'free market' system where profit (at multiple levels) is considered the appropriate metric.

    How exactly is our healthcare anything like free market? Do you get any real choice in provider? Do you know the prices? Do you evaluate cost vs. benefit before buying the service? Does anyone even perceive healthcare as buying a service?

    The reason we have this problem is precisely because healthcare isn't a free market. People see things as being "free" (and will complain bitterly if they're not), and never bother to ask whether or not dropping $10+k on a pointless treatment really matters. (Hell, half the time it's difficult to impossible to figure out what the cost is anyway. Good luck getting a straight answer on that, when the quoted "price" is 4x what would be normally be paid by a healthcare provider.) If there's no cost, there's no competition and no cost-benefit analysis.

    When it comes down to it, even thought the service is technically provided by the private sector, the only choice you have in it is, essentially, who your employer is (to the extent you can call that a choice). Even in an illegal conspiratorial oligopoly you can at least pick your poison. As it is you pretty much get what get and nothing if you don't want it (but you'll still be paying for it anyways). If that's a free market then so was communist Russia.

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

    by englishknnigits ( 1568303 ) on Monday April 02, 2012 @01:38PM (#39550915)
    Because we foot the bill for most of the R&D and other countries get to reap the benefits using generics that don't have to subsidize the enormous R&D costs.
  • Re:We all know why (Score:5, Insightful)

    by dave420 ( 699308 ) on Monday April 02, 2012 @01:40PM (#39550945)
    Because those countries care about preventative medicine, where doctors can help people without ever seeing them by giving them lots and lots of good advice and support tools (helplines, advertising campaigns, even the lowly pamphlet), which clearly wouldn't work in a place where doctors depend on patients for their income. Surely they make more money healing someone than preventing them getting sick. In UHC countries, exercise, smoking, diet, etc. are all priorities for the healthcare industry, as it saves them (and the taxpayers) money if the public is advised efficiently about various dangers in their lives.
  • Re:We all know why (Score:5, Insightful)

    by KhabaLox ( 1906148 ) on Monday April 02, 2012 @01:50PM (#39551101)

    why is it that those that can afford the very best fly across the world to get their care in the U.S.

    People from all over the world who can afford the very best order their high end sports cars from Italy. Therefore, all Italians must drive the best, fastest cars in the world.

  • by jedidiah ( 1196 ) on Monday April 02, 2012 @02:06PM (#39551301) Homepage

    No one that has any training in chemistry will seriously suggest that you actually heat plastic together with your food.

    Had that fight with the spouse for years before the whole BPA thing hit the news.

    The risks are far too great if your wrong and the benefits are far too trivial even if you're right.

  • by glop ( 181086 ) on Monday April 02, 2012 @02:39PM (#39551689)

    That's a rather accurate and complete description.
    I only have a couple things to add.

    The quoted price is what you risk paying if you don't have insurance. So a high quoted price is something good for the insurer as it will scare you into buying their overpriced services.
    Some insurers might pay more than others for the same service, so one could think they would want to reduce the "quoted price" so they all benefit by paying less. But I am more and more convinced they actually benefit too much from the absence of reasonable public prices and therefore are trying to keep the non-transparent pricing in place.

    I am not familiar with many drugs, but the few I know make it clear that your insurer doesn't care about getting you a good price for drugs. The copay of drugs can be 2 to 3 times more than the list price or quoted price of the same drug in France (whereas food, clothing, gas and many other commodities are rather cheaper in the US). This is a clear indication that the insurance company acts like a broker that helps you buy services but it actually doesn't care if you get ripped off. The only meaningful difference is that in France, the insurance company negotiates the list price down. So everybody, even those who don't have insurance benefit from the negotiation.

    If we were able to switch insurance providers easily, we would be able to choose the best brokers and also the best coverage. The only issue is that you don't want freeloaders in the system, so you need a minimum level of coverage that people must get. Otherwise they can just go with a dummy insurance for 2$ and then when they are sick they can just benefit from our humanity (i.e. we are human so we won't let them without care when they show up at the emergency room).

    Overall, healthcare is an issue that is both social and individual. Therefore it can't be simply handled by pure market or pure governmental solutions. But at least we should make sure we have working market components in the solution and working governmental components too.

  • by nine-times ( 778537 ) <nine.times@gmail.com> on Monday April 02, 2012 @02:54PM (#39551835) Homepage

    The reason we have this problem is precisely because healthcare isn't a free market.

    I'm not a total free-marketer, but I have to agree at least this far: the problem is that we have built a system that is neither a free market nor a socialist system, but instead borrows from the worst qualities of both.

    Most people don't have a choice in healthcare nor do they have a clear idea of what costs they're paying, or what costs they would be expected to pay if they faced an emergency. Health insurance has been heavily subsidized by the federal government for decades. On the other hand, it isn't regulated very well, the costs aren't made transparent, and it's run as a for-profit venture. You basically have a subsidized government monopoly without serious regulation or even the supposed motive of helping people.

    In my view, we should basically pick one road or the other. The way we have things set up right now is just corporate welfare, but nobody really wants to end it. Conservatives like corporate welfare because their economic theory boils down to "give rich people more money, and they'll fix everything." Liberals want the socialized system but want to hide behind some free-market trappings.

  • by T.E.D. ( 34228 ) on Monday April 02, 2012 @03:00PM (#39551905)
    Well, actually the US has four different models that it uses simultaniously. I'll list them roughly in order of how "socalized" they are.
    1. Veteran's Aministration. This system is totally government-run. The hospitals and doctors are all on the government payroll.
    2. Medicare/Medicaid. The doctors and hospitals are paid based on services rendered, but the US Government is paying all (or nearly all) of the money. Essentially the US Government is acting like one really large insurance company, with your taxes being the premiums (even if you aren't covered). About 1/4th of US residents are under model 1 or 2.
    3. Private insurance. The doctors and hospitals are paid based on services rendered, but a private insurance company is paying a large portion (if you are lucky the lion's share) of the bill. They in turn get their money from whoever pays their premiums. If that is a company, they are passing the costs of this on to their customers, making them less competitive in a global marketplace that includes companies in other countries that don't have to do this. About 46% of US residents are under this model.
    4. "Free Market". This person has no coverage of any kind. They generally don't go to doctors, because almost none of them can afford it (if they could afford such things, they would have bought into option 3). If they get sick enough that it's obviously life-or-death, they go to the most expensive place in the system (an emergency room) where they have to be treated by law, and then generally don't pay because there's no way a typical person can pay a sudden ER bill in the 10's of thousands of dollars or more. So their treatment ends up being paid by users of option 2 or 3. More than a quarter of US residents are using this model, and the percentage is increasing [gallup.com] every year.
  • by jmactacular ( 1755734 ) on Monday April 02, 2012 @03:11PM (#39552023)

    Exactly. Insurance disconnects market forces that would otherwise put downward pressure on price and consumption of services.

    Here's a personal example:

    During a recent visit to the dermatologist, he casually says he's sending me down to get some blood drawn to run some tests. The nurse takes my blood, and I go home. Three weeks later, I get the bill, for over $1,670 for the "labs." If I had known, that was how much they were going to charge, I would have never allowed them to draw my blood. And this is the problem.

    They compel you to consume a service, without ever knowing the price before you as a consumer are allowed to make the purchasing decision. No ability to shop around, or incentive for competition on price. And you are legally obligated to owe the debt, before even knowing what it will cost you. They just send you the bill for whatever amount they want weeks later. Talk about a business model.

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

    by nbauman ( 624611 ) on Monday April 02, 2012 @04:30PM (#39553015) Homepage Journal

    When I go to a doctor sometimes I will opt not to get a test or take a medication because I don't think it's worth it.

    I don't understand how that works. The doctor says, "You may have cancer, we have to do this test to rule it out." How do you say no?

    The reason we have overtesting in the U.S. is because doctors get paid by procedure, not because patients don't have to pay for it.

    If the test or medication is necessary, you have no choice. If it's not necessary, they shouldn't be giving it.

    In the UK, NICE decides what tests and medications are necessary under what circumstances. Doctors are government employees, so they're expected to follow guidelines unless they have a good reason for doing otherwise. They give a lot fewer PSA tests in the UK. The death rate for prostate cancer is about the same.

  • Re:We all know why (Score:3, Insightful)

    by Dishevel ( 1105119 ) on Monday April 02, 2012 @04:31PM (#39553027)

    That is just not true.
    I was riding my Goldwing back from a day at work where I got called in on a Sunday to get things running again.
    I was out riding in the morning so I came to work on my bike.
    On the way home a guy turned left in front of me. Hit him doing about 40. he took off. Wrecked the bike but I got out of it with a decent chunk of skin missing and massive bruising on my right side. Nothing broken. Got taken to a trauma center and got the full work up to make sure I was not going to die of internal injuries. Spent the night as well.
    Bill came couple of days ago. Almost $24,000. Expensive. Massively so.
    Though I did get great care. The medical system in the US is top notch. Your view of the insurance industry may differ but the medical system itself while expensive as all hell is fast, responsive and can bring massive amounts of care to the critically wounded very fast. Not just can it offer high quality care but in emergencies it does. They do not ask how you are going to pay till after they save your life.
    Luckily we found the guy a few days after the accident. Called the PD and let them know where he lived. So I will not have to pay the bill. But even if I did have to pay. I would rather be in debit than dead.

Our business in life is not to succeed but to continue to fail in high spirits. -- Robert Louis Stevenson