None of this pricing makes sense, particularly when one realizes that no major study has found an association linking the cost of services to quality of care. This lack of a correlation between cost and quality is stunningly consistent across a range of services and procedures. In one recent analysis, researchers using U.S. Medicare data found an inverse relationship between the quality of surgery and its cost. Ponder that for a moment: Higher cost was associated with poorer outcomes—including greater complication rates for all procedures studied, including coronary artery bypass graft, colectomy and aortic aneurysm repair.7
Before we, as cognitive specialists gloat, the results extend beyond surgeons. A recent study observed a wide variation in what internists and hospitalists spent in their diagnostic evaluation of patients and once again, it found no added benefit gained with higher spending.8 When it comes to providing quality medical care, money can’t buy you everything.
Perhaps a more distressing set of results was observed in a study that compared the provision of low-value health services by primary care doctors in community-based practices to those who were hospital employed.9 The services compared included the use of antibiotics for upper respiratory tract infections, computed tomography or magnetic resonance imaging for back pain and headache, radiographs for upper respiratory tract infections and back pain, and specialty referrals for these three conditions.
Visits to hospital-based practices were associated with greater use of low-value computed tomography and magnetic resonance imaging, radiographs and specialty referrals than visits to community-based practices, and visits to hospital-owned community-based practices had more specialty referrals than visits to physician-owned community-based practices. If confirmed by others, these results will cast serious doubt on the cost-effectiveness claims made by large hospital-based systems and their reasons for expanding their physician networks.
It matters where you live. The U.S. counties with the longest life expectancy are affluent areas with high per capita incomes, such as Marin County, Calif., and Summit County, Colo., whereas Oglala Lakota County, S.D., which includes the Pine Ridge Native American reservation, many counties clustered along the lower Mississippi River Valley & parts of West Virginia & Kentucky have the shortest life expectancy, with the difference exceeding 20 years.
Variations on a Theme
Why is there such variation in the delivery and the quality of healthcare? With all the available technology, one might surmise that it would be far easier for practitioners to quickly adapt to newer insights and recommendations and adjust their behaviors accordingly. This has yet to be observed.