Study Used in Medical Insurance Reform Debate is Questioned
Posted on Mon, Jun 14, 2010
The Obama administration had quoted a relatively unknown research group in Dartmouth College, which claimed that it could cut billions of dollars in wasteful medical care spending and make Americans healthier at the same time.
They claimed that the $700 billion a year that is spent on unnecessary testing and procedures does nothing to improve patient's health and can actually be harmful.
In this study, maps were shown that highlighted the waste in the medical system....with beige representing medical facilities and regions that offered good and efficient care, and chocolate representing bad and inefficient care. These maps made reform look easy to so many in Congress that Congress suggested simply trimming the funds Medicare gives to hospitals and regions that were in the chocolate zones.
While this research was interpreted to show the country's best and worst medical care, in interviews, the Dartmouth researchers acknowledged that the charts mainly show the varying cost of care in the government Medicare program. Yet measures of quality of care were not part of the formula. Nobody knows if patients are dying in larger numbers in the beige regions than in hospitals in the chocolate ones.
The research that pointed to which hospitals and regions are the cheapest may be questionable. The main point behind the research is that medical doctors in the upper Midwest give better and cheaper care than their counterparts in the south and in the big cities, and they cited that if Southern and urban medical doctors would be less money hungry and behave like medical doctors in Minnesota, then America would be richer and healthier.
The actual difference in costs between these regions may result largely from how patients live. For example, people living in Houston, TX may be sicker and poorer than those people living in Bismark, N.D. Also, nurses in Houston are paid higher than nurses in North Dakota because the higher cost of living in Houston. In the study, patients' health is not considered, nor is the difference in salaries or medical prices.
More and more medical policy researchers are learning that overhauling America's medical insurance system will be a lot more difficult and more painful than the Dartmouth research has suggested. In fact, the cuts that are made, if not made carefully, could result in losses of life.
One of the main focuses of Dartmouth's research is the comparison between hospitals in regard to spending. The way that they determined spending is by looking at data which shows how much hospitals had billed Medicare for patients with a chronic illness, who only had 6 months or two years left to live.
The research did didn't account for the care that extends life or helps lives. For example, if a medical facility uses a lot of money on 5 patients and keeps 4 alive, while another medical facility uses less money on each patient, and all 5 die, then the medical facility that saved 4 of the patients will rate below the higher spending medical facility because the study only compared how much it spends before a death.
It is true that some medical facilities are spending more, but they're actually getting better results. The Dartmouth research does not give any credit to these hospitals. What's alarming is that this research done by Dartmouth is very influential in America's capital. It has been called the most important research of its kind in the last 25 years, according to Dr. Donald Berwick, who was nominated by Obama to run Medicare.
As a way to gain support for the health legislation, the Obama administration made a promise this past March. They said they would ask the Institute of Medicine, which is an advisory group that is not government related, to find ways of putting the Dartmouth research findings into a plan of action by setting payment schedules that would reward efficient hospitals, and punish the inefficient ones.
If that proposed system punishes big city hospitals, such as UCLA or NYU Langone Medical Center, because they look like big spenders, but may rank much higher by other quality measures, then there is a huge question over the validity of the Dartmouth research.