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Study: Medicare Funds, Quality Not Linked
By Mary Dalrymple, the Associated Press
April 7, 2004
WASHINGTON - Higher spending for Medicare does not necessarily translate into better care, says a study that found patients got less effective treatment in states that spent more on medical specialists.
Dartmouth College researchers studied how often doctors caring for Medicare patients used high-quality, low-cost treatments proven effective for most people.
The 24 treatments measured in the study included prescribing aspirin and beta blockers for heart patients, antibiotics for pneumonia sufferers, mammograms for older women and eye exams for diabetic patients.
Evidence had shown that states varied widely in their use of these treatments, leading the researchers to question whether states lacking effective treatments didn't spend enough on Medicare.
"The answer is no," said study author Katherine Baicker, assistant professor of economics at Dartmouth. "In fact, in the areas where we see the highest spending, if anything there's a lower use of this care."
Baicker and Amitabh Chandra, also an assistant professor of economics at Dartmouth, said they discovered that the states spending the most put those dollars into intensive, expensive care instead of more effective basic treatments.
The higher-spending states also had greater concentration of specialists. States that spent less and delivered better care tended to have more general practitioners.
The study doesn't explain why regions with more specialists delivered less effective care. Baicker said it's possible that specialists concentrate on sophisticated testing, letting the more basic and effective treatments fall through the cracks. Specialists might also spend more time treating an acute condition and less time inquiring about a patient's general health, compared with a general practitioner.
The relationship between Medicare spending and intensive treatment showed up again when the researchers compared the amount of money states spent on care during the last six months of life.
Medicare patients in higher-spending states spent more time in the hospital and were more likely to be admitted to an intensive care unit during their last six months of life. The more intensive care did not improve patient satisfaction.
Researchers concluded the solution is not to cut Medicare spending but to set national guidelines for basic and effective care. Medicare patients should also be encouraged to see general practitioners.
"Improving quality of care has everything to do with how the money is spent," Chandra said. "We need to determine how to make better use of health care dollars, especially with the baby-boom generation about to enter the Medicare system in the next few years."
Medicare's government trustees recently reported that the program will go broke by 2019 - seven years earlier than expected - because of rising health care costs.
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