President-elect Barack Obama may not have to significantly increase health care spending in order to expand insurance coverage, according to a Dec. 17 policy recommendation paper by The Dartmouth Institute for Health Policy and Clinical Practice.
The paper's authors argue that by decreasing wasteful medical spending, the costs of expanding health coverage to the uninsured can be offset.
"We have worked, some of us for the last 20 years, trying to both explore the causes of what's happening in the U.S. health care system and the implications of what we've learned," Dartmouth Medical School professor Elliott Fisher, director of TDI's Center for Health Policy Research, said. "This [policy] paper comes specifically out of that work and tries to make enough concrete recommendations for the next administration."
The paper recommends four main ways to improve health care: promoting the growth of organized systems of care, such as community clinics where patients can receive a variety of services; requiring informed patient choice and shared decision making to ensure that patients receive only the care they want; establishing a federal physician workforce policy that caps graduate medical training posts funded by Medicare; and funding the continuous evaluation of health care costs and practices nationwide.
"If these policy reforms are implemented, it could have a dramatic positive change on not only the quality of care, but also the way patients feel as though they've been treated," said Shannon Brownlee, a lead author on the paper and a visiting scholar at the National Institutes of Health.
The paper states that increased health spending does not necessarily lead to increased patient satisfaction.
For example, patients who live in areas with high Medicare spending did not have better health outcomes.
Informing patients about all of their options could also help decrease wasteful spending by reducing overtreatment, such as excessive end-of-life care or unnecessary medical tests, TDI director and DMS professor James Weinstein said.
"We want to give patients information that's unbiased in ways that helps them make decisions about their treatment options," he said, describing the success of videotapes and DVDs distributed to patients by TDI's Center for Informed Choice.
Weinstein said he hopes distributing such resources will become common practice at hospitals across the country in the near future.
"That would be the least intrusive -- probably the least expensive -- change, and it would benefit the most people," he said.
Much of the paper's data was from research for the Dartmouth Atlas of Health Care, a project initiated by DMS professor John Wennberg, one of the paper's lead authors, when he was TDI director in the early 1990's.
The Dartmouth Atlas project tracks disparities in the distribution of health care across the United States.
"The Dartmouth Atlas basically says that depending on where you live, you get different treatment, and that amount of variation is probably more than what a system should have," said Weinstein, who also coauthored the paper. "That turns into billions of dollars."
In addition to the four recommendations discussed in the TDI paper, Weinstein said decreasing the variation highlighted in the Dartmouth Atlas is necessary to improve the current system. He noted that data from the Dartmouth Atlas has long been accepted in Washington.
"The Dartmouth Institute has been a recognized expert in studying U.S. health care for a long time, and lots of people refer to our data when they're talking about U.S. health care in general," he said.
To involve undergraduates in its work, TDI has talked to Dean of Faculty Carol Folt about possibly creating a health policy minor, Weinstein said.
"It's a potentially exciting way for students to get more involved," he said.
TDI is a valuable resource for College students, Folt said in an e-mail to The Dartmouth, but that more discussion is necessary before the College can approve a health policy minor, she said.
"I see finding ways to involve the outstanding TDI faculty with our students and other faculty as a top priority, and so I am looking forward to seeing what can be developed in the coming months," Folt said.
Fisher said the paper has been sent to numerous Washington officials, including former Senate majority leader Tom Daschle, D-S.D., Obama's pick for Secretary of Health and Human Services.
"We hope he reads it," Fisher said, referring to Daschle.
Wennberg and economics professor Jonathan Skinner, the third coauthor, were unavailable for comment.
