Up, Up and Away
By Marjorie Howard
Hospital health-care quality goes up, but often costs rise much faster, study finds
Spending more money on health care does not necessarily improve outcomes, Tufts researchers have found. In fact, a study of the treatment of seven common conditions at 122 hospitals found no correlation between increased spending and reduced mortality.
Mortality measures from the different diseases are improving relatively quickly, says Michael B. Rothberg, an associate professor of medicine based at Baystate Medical Center in Springfield, who led the study. “But at the same time, costs are going up very quickly,” he notes. “The degree of increase in the cost and the degree of decline in mortality are not correlated one with the other. So for one diagnosis, the cost is going up fast, but there’s not much improvement in the outcome. In another diagnosis, the outcomes are improving, but there is not much increase in cost.”
The study, which was published in the August issue of Health Affairs, used data from the government-funded Healthcare Cost and Utilization Project, the largest collection of longitudinal hospital care information in the U.S. It looked at patients treated for strokes, myocardial infarctions, sepsis, pneumonia, congestive heart failure, urinary tract infections and chronic obstructive pulmonary disease in 26 states between 2000 and 2004.
For some of these conditions, Rothberg says, “the money we spent bought us a lot,” as the improvements in care were relatively inexpensive for heart attacks, pneumonia and stroke. But in other cases, more spending did not help. The cost of treating sepsis, a bacterial blood infection, for example, went up by 40 percent, while the mortality rate dropped just 1 percent.
Other countries, Rothberg says, pay more attention to cost than the United States does. “The whole way our health system is built is on private enterprise and fee for services. We don’t have a national health system that is looking at costs. Insurers that look at costs often lose their subscribers, so they pay and pass the cost along to consumers.”
Rothberg says any follow-on studies will need more information about what the money is actually spent on. “We adjusted for general inflation, but you could have specific inflation in physician wages or medications, so you could be providing the same care, and it costs more,” he says. “Or it could be they’re using different kinds of interventions that are more expensive but not more effective.”
Rothberg says the study “provokes questions” but that “it’s exciting to wake up people to those questions. As a health-care system, as consumers and as a country, we really haven’t paid much attention to this. We’re only interested in improvements in outcomes and don’t care about costs,” he says. “The result is the costs have gone up and up and up. In general quality has improved, but it’s not necessarily related to increases in cost.”
Marjorie Howard can be reached at firstname.lastname@example.org.