April 9, 2008
Albuquerque Journal
Is More Health Care Too Much Health Care? ( Editorial)
How can the best medical care in the world cost twice as much as the best medical care in the world?"
--Peter R. Orszag
Congressional Budget Office
A new report out of Dartmouth Medical School may offer the first real advancement when it comes to figuring out how to keep Medicare solvent while giving the chronically ill the best care.
It boils down to "the best" is not "the most."
The Dartmouth Atlas of Health Care, released Monday, found glaring disparities in how much Medicare spends on the care of chronically ill patients in the final two years of life. It's important to note those disparities— more than $105,000 at NYU Medical Center vs. $93,842 at UCLA Medical Center vs. $53,432 at the Mayo Clinic vs. $37,632 in New Mexico— had no impact on outcomes. The study looked at records of 4.7 million patients whom co-author Dr. Elliott Fisher says "all were dead in two years."
So what did patients outside of New Mexico get for the extra $15,800 taxpayers shelled out in Minnesota, the added $56,210 they forked over in Los Angeles, the bonus $67,368 in Manhattan?
More days in the hospital and more doctor visits. But Fisher points out those patients did not live longer, on average, and "we know that hospitals are dangerous places if you don't need to be there."
As well as expensive. Medicare, which had a budget of $432 billion in 2007, is on track to go broke in 2019. Chronic patients in the last two years of life account for one third of Medicare's expenses— about $1 out of every $3. For an entitlement program that's struggling to control costs, the Dartmouth study could offer real relief in place of slashed reimbursements and curtailed coverage.
NYU's chief medical officer, Dr. Robert Press, told the New York Times "it's not an easy fix. We are dealing with a culture of physicians who have been very aggressive in their care and a patient population that has desired this type of care."
But it appears the only outcome of that care is a bill relegating future patients to no care at all.