Higher Medicare spending does not correlate with better treatment for patients, according to the 2008 edition of the Dartmouth Atlas of Health Care, published last month. The Atlas traces the distribution of medical resources at hospitals in different regions across the country.
"If anything, the care is slightly worse in higher-intensity hospitals," Dartmouth Medical School professor Elliott Fisher, the Atlas principal investigator, said. "If you spend more, you don't always get better care."
National medical costs could be reduced by 20 to 30 percent if all hospitals were as efficient as low-spending hospitals, Fisher estimated.
The disparities in care are based on how long similar patients are kept in the hospital, how frequently they see their primary care physicians and how many other doctors they see during their visit, according to Fisher.
"There are tremendous differences across hospitals in how much care they provide chronically ill patients," Fisher said.
Patients in hospitals that spend more tend to receive worse care because of poor coordination between staff members, and at places where spending is more aggressive, patients see a wide variety of doctors, making systemized care rarer, the Atlas found.
"There are a lot of issues around care coordination," Fisher explained. "As we have more and more specialties and specialists, patients have a lot more doctors."
This year's Atlas, "Tracking the Care of Patients with Severe Chronic Illness," studied Medicare bills for chronically ill patients in the last two years of their lives. The Atlas compares data from 306 hospital regions in all 50 states.
"Medicare keeps records of all beneficiaries and records of all their medical care," Fisher said. "We use their hospital and physician bills to find what kinds of care they got and how much was spent on them."
Because there is no comprehensive data source of amounts spent on patients under the age of 65, it is hard to compile a report on non-Medicare patients, Fisher said. If hospitals are cost-effective in their treatment of Medicare patients, however, then they are generally cost-effective in their treatment of all other patients, Fisher explained.
Many Americans maintain the misconception that a major problem with the health care system today is a doctor shortage, Fisher said. The number of physicians, though, is adequate, he asserted.
"The underlying problem is with the delivery system," Fisher added.
The per capita health care cost is currently $7,000, Fisher said, a cost that many American are increasingly unable to afford. A goal of the Atlas is to inspire health care reform to ensure that patients are receiving the best care in the most efficient way.
"We can afford to cover everybody," Fisher said. "If people can understand the lessons of the Atlas, patients would be getting better care, and care that they really wanted. We need to invest in learning how to give them better care."
The report found that residents of New Jersey, New York and Washington, D.C., spend the most time in hospitals and see the most doctors when ill, while Idaho, Oregon and Utah residents were at the opposite end of the researchers' spectrum. New Hampshire was ranked 11th from the bottom of the index. Dartmouth-Hitchock Medical Center is "pretty conservative" in keeping patients at the hospital, Fisher said.
John Wennberg, a professor at DMS, founded the Dartmouth Atlas in the 1990s with funding from the Robert Wood Johnson Foundation.
