Research Suggests More Health Care May Not Be Better (GINA KOLATA, July 21, 2002, NY Times)

"If there are twice as many physicians, patients will come in for twice as many visits," said Dr. John E. Wennberg of Dartmouth Medical School, where much of the new work is being done.

The Dartmouth researchers acknowledge that their findings are unexpected, and some experts say more work is needed to sort out cause from effect.

"These relationships are very difficult to disentangle," said Dr. Rodney Hayward, professor of health policy and management at the University of Michigan. Patients in some regions may be demanding more care, either because they are sicker or because they have come to expect it, Dr. Hayward said; doctors cluster in areas where there is more demand.

Still, Dr. Wennberg and his colleagues say the disparities are too stark to be explained entirely by such factors. In a paper published in February in the journal Health Affairs, they wrote that Medicare's typical lifetime spending for a 65-year-old in Miami is more than $50,000 higher than for a 65-year-old in Minneapolis. In a further analysis, they found that in Miami, where medical services are particularly abundant, the federal Medicare program pays more than twice as much per person per year as it does in Minneapolis: $7,847 in Miami, $3,663 in Minneapolis.

Nor can the gap be explained by regional differences in medical costs, said Dr. Elliott S. Fisher, an author of the paper who is co-director of the Outcomes Group at the Veterans Affairs Medical Center in White River Junction, Vt., and a professor of medicine at Dartmouth. Older Miamians simply went to doctors and hospitals more often. In their last six months of life, they had more than six times as many visits to medical specialists as those in Minneapolis, spent twice as much time in the hospital and were admitted to intensive care units more than twice as often.

Life expectancy is no greater in regions that have more intensive medical care, the researchers find, and Medicare surveys find that their quality of care is no better.

"What increased spending buys you is generally unpleasant interventions like intensive care units and feeding tubes," Dr. Wennberg said.

Considering that health care, particularly for seniors, is no longer a free market, it makes sense that an infinite amount of money will chase any amount of medicine you make available. Of course, the problem is that the money only seems infinite because it's coming from the government.
Posted by Orrin Judd at July 20, 2002 5:12 PM