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For Release: February 08, 2006
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Dartmouth Research Shows Expensive Care Won't Necessarily Buy Better Health

Dr. Jonathan Skinner
Dr. Jonathan Skinner

HANOVER, NH - A new study by researchers with Dartmouth Medical School's Center for the Evaluative Clinical Sciences (CECS) finds that the enormous improvements in outcomes for heart attack patients is not linked to the tremendous increases in costs.

Jonathan Skinner, professor of community and family medicine worked with Elliott Fisher, professor of medicine and of community and family medicine and Douglas Staiger, professor of economics at Dartmouth College. All three are members of the interdisciplinary team at Dartmouth's CECS, which measures various aspects of the quality, cost and effectiveness of medical and surgical care.

In a study published online in the Feb. 7, 2006 issue of the journal Health Affairs, the researchers examined Medicare costs and survival of acute myocardial infarction, or heart attacks, from 1986 to 2002. They learned, as others have, that the increases in the survival rates more than justify the increases in costs. However, they also discovered that since 1996, survival rates have stagnated, while spending has increased.

"We found that the factors that yielded the best survival rates were not necessarily the factors that were the most expensive," says Skinner, who is also the John French Professor of Economics at Dartmouth College. "This result is inconsistent with the conventional wisdom that only by spending lots of money can we benefit from high-tech care and the health it provides."

The study, funded by the National Institute on Aging, considered heart attack care along two dimensions. The first dimension included the "low-cost, highly effective" treatments, such as whether patients were given aspirin and beta blockers at hospital discharge and whether they were given reperfusion (procedures to restore blood flow to the heart) within 12 hours of admission. The second dimension of care was the average number of physicians treating the patient within one year of the heart attack, which is a measure of reliance on specialists and continuity of care.

"We found that regions scoring well along the first dimension achieved better outcomes at lower costs than regions scoring well along the second dimension," says Skinner.

He and his colleagues warn that their finding does not promote sharp cutbacks in the low-efficiency, high-cost regions, which could adversely affect quality of care. Instead, they suggest that the organization of care should resemble the most efficient regions that provide higher quality treatment at lower cost.

According to the researchers, this new insight solves a number of puzzles. It explains why there is a disparity between spending and quality of care in a given year, because the less efficient regions are spending more money in inefficient ways that don't result in better health outcomes.

Their paper concludes, "Efforts to develop measures of quality and efficiency that can encourage hospitals or provider groups to adopt low-cost, highly effective care, while discouraging incremental spending with no apparent benefits, might allow us to keep the golden goose of technological progress alive and well nourished."


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