More spending equals better care - in Canada
NEW YORK (Reuters Health) - A new Canadian study suggests that patients treated in Ontario hospitals do better at facilities that spend more money on nurses, specialists and procedures.
The finding raises questions about an idea at the heart of a major argument in U.S. health care reform: that hospitals can provide equal or even better care after government reimbursements are cut.
"What's really interesting about this paper is it's right in the middle of a very topical debate about how we're going to solve our health care spending problem," said Dr. Karen Joynt, from the Harvard School of Public Health in Boston.
"I think it makes a very plausible argument that... we really need to think about what spending is giving us the value for that spending and what spending is just wasteful," Joynt, who wrote a commentary published with the study in the Journal of the American Medical Association, told Reuters Health.
The lead author of the study, Therese Stukel of the Institute for Clinical Evaluative Sciences in Toronto, said a past study of U.S. hospitals showed that patients in higher-spending regions didn't live any longer or get better care than those treated at hospitals that spent less money.
The theory has been that those high-spending hospitals could find a way to cut back without patients suffering as a result.
To see how costs and care compared in Canada, which has a universal health care system, Stukel and her colleagues tracked patients admitted to one of 129 different Ontario hospitals between 1998 and 2008 with a heart attack, heart failure, hip fracture or colon cancer -- about 388,000 people in total.
The researchers separated hospitals into low- and high-spending based on the average cost of all the services they provided to patients in their last year of life -- which reflects how intensely hospitals treat similarly ill patients, they explained.
That cost varied by facility from about $22,000 worth of doctor time, tests and procedures to almost $45,000.
Higher-spending hospitals were often teaching hospitals in urban areas, with more nurses and also the space and equipment to do more tests and procedures.
And, those qualities seemed to translate into better care. The researchers found that colon cancer patients, for example, were more likely to have a pre-surgery consultation with doctors at higher-spending hospitals, and people with hip fractures more often got inpatient rehab at those hospitals.
Patients at higher-spending hospitals were more likely to have a specialist visit during their stay and less likely to go to the intensive care unit.
More spending was also tied to better outcomes: fewer patients died within a month of being admitted to higher-spending hospitals. For example, 10.2 percent of people treated for heart failure at high-spending hospitals died within 30 days, compared to 12.4 percent treated at low-spending hospitals.
For hip fractures, those numbers were 7.7 percent and 9.7 percent who had died one month after treatment at high- or low-spending hospitals, respectively, and for colon cancer, 3.3 percent and 3.9 percent.
The difference was small for heart attack patients: 12.7 percent of those treated at high-spending hospitals died within 30 days, compared to 12.8 percent treated at low-spending hospitals.
The findings suggest more spending isn't necessarily bad -- as long as it's going to the right places, like more nurses where they're needed and timely evidence-based procedures, researchers concluded.
"Basically the lesson is, be careful in managing your resources," Stukel said.
The U.S. has far more specialists and testing equipment than Canada, she said, but doctors often use it when it's not needed, driving up costs unnecessarily, and care generally isn't well coordinated between patients' multiple doctors.
According to World Health Organization data from 2009, the U.S. spent about $7,400 per person on health that year, compared to about $4,200 in Canada.
Joynt said that hospitals and health care systems in the U.S. need to look more closely at spending and outcomes to try to pinpoint where money is being well spent, and where it's being used inappropriately.
"It's very much about trying to be efficient and thoughtful about the healthcare system as a system, as opposed to a bunch of individual physicians and patients and nurses and hospitals," she said.
SOURCE: http://bit.ly/4HWZ7 Journal of the American Medical Association, online March 13, 2012.
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