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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 haemish ( 28576 ) * on Monday April 02, 2012 @12:46PM (#39550159)

    The last months of a persons life are overwhelmingly the most expensive, but the outcomes are predicable. There was a great article in the WSJ on this called Why Doctors Die Differently - [] . The basic point is that doctors understand death, and when their condition makes death inevitable. They almost always opt for more life in their years than more years in their life. From a healthcare point of view, doctors have much less expensive end-of-life care.

  • by NeutronCowboy ( 896098 ) on Monday April 02, 2012 @12:51PM (#39550245)

    Not surprising. Sick people cost more than healthy people. At any given time, less people are sick than are healthy. Furthermore, there is a small segment of chronically ill people.

    Note: the reason why health care needs the biggest pool possible is because at any given time, you cannot tell who will need expensive health care. Our health care isn't good enough to predict who will get what disease and when, or who will get into an expensive accident. This means that unless you want to bankrupt 5% of the US population and keep them permanently in the poor house, you need a national health care system. Otherwise, the health care system will trend to cost+profit+cost to help uninsured people.

  • by CanHasDIY ( 1672858 ) on Monday April 02, 2012 @12:54PM (#39550279) Homepage Journal

    ... for the US having a government not basing its policies on adages, witticisms and one-liners.

    You sure about that bro?

    Are you now, or have you ever been, a member of the Communist Party?

  • by garcia ( 6573 ) on Monday April 02, 2012 @12:56PM (#39550327)

    I read that article when it came out and agreed with all of it. However, in many cases it's just simply not as easy as the article makes it seem.

    My grandfather passed away several years ago after living for the better part of a decade mentally and physically incapacitated following a serious brain hemorrhage. My father, having power of attorney, noted that he was not to receive anything other than painkillers. He was simply supposed to be made comfortable but no effort was to be made to prolong his life. The cost of that nursing home was astronomical even for care which is basic.

    There is also my remaining living grandparent. At 86 she is able to walk by herself, communicate clearly, etc. She also has a ton of health issues including diabetes, pain management, etc. Her costs, mostly shouldered by the taxpayers due to very low available income, are also astronomical and she's living what many may consider an active and acceptable lifestyle for her age.

    So yeah. Doctor's (and many others) choose to die quickly and w/o medical intervention which is likely to fail anyway. However these astronomical costs aren't just for those who are likely terminal patients. They're for everyone--even the "healthy" ones.

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

    by ColdWetDog ( 752185 ) on Monday April 02, 2012 @01:05PM (#39550455) Homepage

    Won't work until you have a much higher penetrance rate for HDHP (HIgh Deductible Health Plans). Right now, anyone with an HDHP gets royally screwed paying top dollar for the care they do get. It does tend to prevent people from using health care resources, but given the broad brush you're sweeping with, that's not necessarily a good thing.

    The idea that HDHPs will actually decrease billed costs to something more reasonable (no $60 aspirins) has yet to be shown. It puts the burden on the wrong person and typically will only be used by intelligent, reasonably well off, healthy people - a small subset of the total population.

  • by Kagato ( 116051 ) on Monday April 02, 2012 @01:33PM (#39550841)

    The states with some of the lowest Health Care spending (compared to other US states) have the best outcomes. You look at a state like Minnesota which is highly regulated, mandates Health Insurance Companies are not for profit and allows "never pay events" (medical mistakes neither the patient nor insurance company have to pay) and they have some of the best outcomes.

    I'd also point out that high medical costs are often attributed to lawsuits. I would point out that Texas passed Tort reform a long time ago and the highest cost counties in the US are in Texas.

    Bottom line, you want lower cost health care you restrict profiteering and you don't reward bad behaviors by doctors or insurance companies.

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

    by englishknnigits ( 1568303 ) on Monday April 02, 2012 @01:35PM (#39550875)
    I have an HDHP (shocker) and it saves me lots of money. My monthly premiums are much less plus I can pay for my expenses with a tax deductible account. Going to a specialist will cost me between $90 - $200 assuming I don't get any crazy tests/procedures which is what I save every month on the premium alone. When I'm really sick and need to see a doctor, I go. If I'm feeling so so I may wait and try to avoid the cost if it doesn't seem serious. 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. If you don't have to pay to get name brand, why bother getting generic. If you don't have to pay for meds, why not just get them? If you don't have to pay for an office visit, why not go "just in case"?
  • by vux984 ( 928602 ) on Monday April 02, 2012 @01:46PM (#39551033)

    What happened to family taking care of their own?

    You need a house with an extra bedroom.
    Someone at home around the clock. need a single income family in a house with extra rooms... In an age of dual income families who both have to work just to afford living in a small condo.

  • Re:No, it does not (Score:5, Interesting)

    by LanMan04 ( 790429 ) on Monday April 02, 2012 @01:46PM (#39551035)

    Living in Canada, I can tell you - our healthcare system SUCKS. Have a broken arm? Go to the emergency room and sit there for 4 to 6 hours for someone to attend to you...

    The exact same thing happens in the US (triage is triage, after all), and then you get a $3000 bill in the mail.

    Sounds great, right?

  • by Moses48 ( 1849872 ) on Monday April 02, 2012 @01:47PM (#39551053)

    Still want to put that $90k under her nose and offer to have her sign her death certificate to get it? No, I didn't think so.

    While I don't think that's the best solution, I think it's much more equitable than what we have today. As long as she is informed of all the ramifications.

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

    by Dixie_Flatline ( 5077 ) <vincent DOT jan DOT goh AT gmail DOT com> on Monday April 02, 2012 @02:01PM (#39551237) Homepage

    As a Canadian, I can answer why Canadians would do this.

    Firstly, there's a chance that the Canadian government will pay for your treatment anyway. These cases aren't super common, but they (actually, the provincial governments) will cover procedures that are hard to get or experimental in Canada under certain restrictions.

    Secondly, if you have the money, everything is possible, no matter where you live. The reason why America is so enticing is precisely why it fails its own citizens (IMO): there is excess capacity. If you have money, there are doctors and hospitals that have a lot of extra room for you because they're not concerned with serving people without money or insurance (until it's an emergency). In Canada, the queues are full. The people have been triaged, and rich or poor, they've got to wait. Someone that makes a million dollars a year doesn't get to jump the line because of their income, and someone that barely scrapes by can be assured that they'll get their care. So if you're rich in Canada and you can afford not to wait, you may skip out of the country to get an operation somewhere else. (Frankly, this is something I encourage. It makes the lines shorter for everyone else.)

    Care at the very high level in the US is extremely good; nobody in their right mind argues with that. American researchers and surgeons are often also the ones performing new and different techniques, so your system is on the leading edge.

    So, yeah. The American system works for people that don't live in America precisely because it ISN'T fair, and the system inside my country is a level playing field that the rich don't want to wait on. (This is not a criticism of the wealthy in Canada, per se. As far as I know, they think our system is as great as the rest of us do. But they have the money, and they can decide how to spend it.)

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

    by Comboman ( 895500 ) on Monday April 02, 2012 @03:13PM (#39552049)

    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.).

    But healthy living (exercise, smoking, eating right, etc.) is all a part of true health care, it's just not a part of critical health care. Health care dollars spent on prevention are far more effective than those spent on critical care.

  • Re:Hold on a second (Score:4, Interesting)

    by meburke ( 736645 ) on Monday April 02, 2012 @07:25PM (#39554935)

    Yeah, I'm sorry, but health care is price-controlled in major ways, particularly Medicare and Medicaid, and that is a de facto subsidization.

    Furthermore, it is an Economic principle that anything that is price-controlled causes a shortage of the good controlled and causes higher prices. This may be the one thing that almost all Economists actually agree on, and it is based on 4500 years of historical records.

    I was just reading an article about a doctor who had a 12-person office until last December. In January he quit taking Medicare and Medicaid patients, and quit taking insurance. He was able to lower his prices 14% and improve his revenues by 22%. He now runs his office with 4 people. (Let's not forget that filling out insurance forms and so forth are still services, but now they are in shorter supply.) The motive for declining insurance and MM? MM did not pay the expenses and were costing him a great deal of money and aggravation. Statistics vary according to specialty, location and survey source, but the number of doctors not taking new medicare patients seems to be somewhere between 12% and 19%. .This range is up about 4% from 2009.

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