founding father

By ELLIOTT S. FISHER

HANOVER, N.H. — No one in Washington is completely satisfied with the
Medicare legislation that Congress approved last week. For many
conservatives, the shift toward private health plans is too limited; for
many liberals, the new prescription-drug benefit is too stingy. Yet almost
everyone agrees that the current bill worsens the program's long-term
financial stability.

Constructive debate about Medicare's costs, however, is hampered by a flawed
assumption that both helps and is reinforced by the health care industry:
that more care — and more expensive care — is better care.


The difference in spending is almost entirely due to the way medicine is
practiced in high-cost regions. Compared with similar patients in Portland,
Medicare enrollees in Manhattan spent more than twice as much time in the
hospital and had twice as many doctor visits per year. The additional
services provided in higher spending regions are largely discretionary, like
more frequent visits to specialists, longer hospital stays and more frequent
use of diagnostic tests and minor procedures. Remarkably, more spending does
not lead to more people receiving expensive and proven treatments, like
cardiac bypass surgery or hip replacement.


What was surprising is that quality was actually somewhat worse in regions
that provided more care, with less frequent use of proven treatments for
heart attack patients and of preventive services. Meanwhile, access to care
and satisfaction were worse or no better than in regions that provided less
care


Better information will allow us to get the incentives right. The backlash
against "managed care," which was evident in the Congressional debate over
Medicare, has been driven largely by the fear that beneficial treatments
were being denied because doctors were paid more to provide less. But
unmanaged care and unfettered growth can also be dangerous. If health care
organizations were held accountable for improving the quality and efficiency
of care, patients might believe that excellent care and lower costs are
compatible.


Our study suggests that perhaps a third of medical spending is now devoted
to services that don't appear to improve health or the quality of care — and
may make things worse. It also shows that we have sufficient current
capacity to cover the uninsured — without necessarily increasing spending.
(All that would happen is that the well-insured would see their doctors less
often and, perhaps to their benefit, spend less time in the hospital.)

Members of Congress are right to be concerned about increases in federal
spending. The debate over Medicare underscores the challenge: how to pay for
better care, not just more care.


Elliott S. Fisher is professor of medicine at Dartmouth.

founding father

Sorry, forgot the URL for the complete article:

http://www.nytimes.com/2003/12/01/opinion/01FISH.html

bettinared

It's true that "more" doesn't mean better. Unnecessary high-tech
tests, overmedication (much of it due to overmarketing by
pharmaceutical companies), and more emphasis on invasive and expensive
interventions late in deisease than on early preventative care -- all
these are examples of more being worse, and all are encouraged by our
market-driven health care system.

george conklin

news:<PpUyb.131$k36.82073@news.uswest.net>...

for

Too much medical care is harmful to your health.

skeptic

It does not NECESSARILY mean better. In many cases it obviously does.
Given equal levels of competence between two physcian groups, if you are
injured in a car wreck, do you want to go where they have state of the art
operating rooms, emergency room warming lamps, CT scans, MRI's, etc. OR
.... or do you want to go to the one where they don't even have a machine to
adequately sterilize a knife that was used to cut into the HIV infected
patient next door?

Extreme example to prove an obvious point - more CAN be better, and often
is. The question is, at what point have plataued? My answer: not yet, not even close.

Ah yes, they exist, of course. But don't ignore the high tech tests that
save lives, lead to less pain, afford a more comfortable standard of living, etc.

Some examples, and their proof?

Interventions are becoming LESS and LESS invasive as technology progresses.
Educate yourself before giving your half informed opinions.


These issues are not related. We will always need preventative care and yet
people will always be sick and need treatment/care - one does not prevent the other.

As you can see, they are not. They are the spinning of your yarn into a tangled ball.

The goal has always been, and continues to be, how to best treat the
patient.

skeptic

"George Conklin"

And who will define "too much" George? You? Who is responsible for
excessive care? I saw a patient today who several years free of cancer post
operatively. We have been seeing him every six months. There is no need
for such close surveillance. I suggested we extend his next visit to one
year. He came close to a full blown panic attack. He'll be back in clinic
in six months - again.

george conklin

You point is what? The publicity that you have to go to the doctor to
be well has worked very well in the past to pump up medical demand, as you
have just shown. However, about 30% of men and about 20% of women don't go
to doctors at all if they can avoid it. Some tests, such as occult blood
tests for colon cancer prolong life; they very popular PSA test does not,
but that does not stop the panic men feel if they don't get the test. It
goes on and on.

george conklin

Of course as the machinery increases in quantity, more and more tests
are done, which is what is being blamed for the rise in the cost of
medicine. If a machine exists, it must be used to justify its cost.

skeptic

There is more to medicine than the prolongation of life.

skeptic

New tech is expensive, yes. They increase costs, yes. They by no means
account for the majority of cost increases in the healthcare system. People
buy the machines they think will be helpful ... not use random machines that
they have simply for the sake of using them.