Health debate looks to DMS data

by Susan Matthews | 8/6/09 10:00pm

Correction appended

As legislators and public officials in Washington continue the push for U.S. health care reform, the 35 years of research conducted by a group of Dartmouth doctors on how to improve the efficiency of health care has been incorporated into the debate, Dartmouth Medical School professor David Goodman said in an interview with The Dartmouth Thursday.

Goodman is a researcher at The Dartmouth Institute for Health Policy and Clinical Practice, an institute responsible to the DMS which investigates health care systems in the United States. One component of TDI is the Dartmouth Atlas of Health Care Project, which publishes monthly reports on how medical resources are distributed and used across the nation.

Members of TDI have presented the results of their studies before Congress and the Senate, and Elliot Fisher, primary investigator of the Dartmouth Atlas Project, has been in contact with the executive branch, Goodman said.

"We have a long history of doing this work and the science is very good," Goodman said.

In the first six months of this year, TDI's research was covered in "117 million media impressions in 200 unique media outlets," he said. The findings of the TDI have been referenced in various major news outlets throughout this year, and Goodman said that he has spoken with reporters from "60 Minutes" and Forbes.

The publication of The Dartmouth Atlas has made the research much more accessible and widespread, according to Goodman.

TDI aims to "achieve a patient-centered, high quality, cost-effective health-care system with access and excellence for all," according to its web site. TDI currently houses "dozens and dozens" of projects and research initiatives, Goodman said.

"What we do here is study variation in health system performance," he said. "We learn about what's good and what is problematic with health care, and come up with ideas about how to change the system we have."

The research has recently become very relevant in terms of the national debate over health care in the United States, Goodman said.

"We're really caught in a dilemma in this country, in terms of those who pay for health care because we're gradually bleeding ourselves dry," he said. "At the same time, we recognize that there are people that aren't getting the kind of care they need."

Debt resulting from medical bills and cost of treatment for illnesses are the most common cause of bankruptcy in the United States, according to Goodman.

Through its research, TDI has found three areas that could be improved within the current U.S. health care system organizational reform, payment reform and constraint in capacity growth, Goodman said.

Because of increased specialization of care, hospitals often lack files detailing the entire health profile of each individual, which leads to problems when the patient moves to a different doctor or location, he said.

A further problem is that there is "no one there to teach them how to change their system," Goodman said.

Under the U.S. health care system, patients "pay for volume," or how often patients seek treatment, instead of paying "for care," or the treatment treatment itself, Goodman said. Hospitals, therefore, tend to increase their capacity only by evaluating need at an institutional level, considering how to expand the amount of care they can provide.

"What happens is doctors look to keep busy and they get paid for higher volume," Goodman said.

He emphasized that the solution does not require a sacrifice of quality but simply an increase in the efficiency of the U.S. health care system.

"Quality and efficiency are partners, not competitors," he said.

**The original version of this article incorrectly stated that Elliot Fisher is the director of TDI's Center for Health Policy Research. In fact, David Goodman holds that position, while Fisher is the primary investigator of the Dartmouth Atlas Project.*

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