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GOVERNMENT & MEDICINEMore Medicare services, quality not always linkedNew research adds evidence to this health policy school of thought.By Markian Hawryluk, AMNews staff. April 26, 2004. Washington -- A new study has revived a Medicare conundrum: providing additional health care services seems to do little to improve the overall quality of care provided to patients. Researchers from Dartmouth College in New Hampshire found that states in which Medicare beneficiaries were provided a greater amount of services or more expensive procedures scored lower on quality measures than states that relied more on primary care services. The study, published on the Web site of the policy journal Health Affairs, looked at 24 quality measures developed by Medicare's Quality Improvement Organizations for use in hospitals and also looked at various patient satisfaction measures. The researchers found that providing an additional $1,000 worth of services corresponded with an overall quality ranking almost 10 slots lower. In New Hampshire, which had the highest overall quality ranking, Medicare spending was about $5,000 per patient in 2001, while Louisiana had the lowest quality position even though expenditures were about $8,000 per individual. The researchers also found a correlation between spending and the percentage of specialists. States where more physicians are general practitioners had higher quality of care and lower cost per beneficiary. Increasing the number of general practitioners by one per 10,000 residents translated into a quality ranking 10 positions higher and per-beneficiary spending $684 lower. But the study may not have adequately measured the benefits of having greater access to specialists in certain cases. "They may be better at the treatment of more acute conditions," the authors said. "Although specialists may not drive the provision of effective care, they often provide better care in their area of specialty." [...]Full text of AMNews content is available to AMA members and paid subscribers.
Copyright 2004 American Medical Association. All rights reserved.
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