Does Higher Spending Produce Better Quality?

RAND literature review:

Of the 61 studies, 21 found that higher spending correlated with better care quality, 18 showed a link between higher spending and worse outcomes, and 22 indicated no difference or an unclear outcome based on spending. The researchers wrote that the findings “suggest that the association between health care costs and quality is still poorly understood.”

That last sentence is an understatement.

Comments (7)

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  1. Buster says:

    Is a Mercedes automobile higher quality than a Chevy? In most cases the answer is a resounding yes! If you ignore legacy costs such as poorly negotiated labor contracts, Mercedes probably spends more on inputs than Chevy. In medicine higher spending generally involves more services and more diagnostic tests. More care doesn’t always improve outcomes. But more resources generally provides greater opportunities to solve problems.

  2. seyyed says:

    as long as the is being spent efficiently then it should produce better quality care

  3. Gabriel Odom says:

    More spending by whom?
    If I spend more on my healthcare, then I expect – and will therefore demand – higher quality of care. However, if the dollars spent to care for me are not mine, I am less likely to vehemently pursue higher quality care.

    As an analogous example, consider the free pizza given to university students at rallies. The students did not pay for the pizza directly, so they don’t complain if the pizza is a bit cold or not their favourite topping. They eat their free pizza because they are hungry. Now consider the same pizza served to you at a pizzeria. You ordered a sausage and peppers pizza, but a cold, mushroom pizza arrived instead. Wouldn’t you complain? You would; and if your pizza wasn’t fixed, you may never return. You have a vested interest in this pizza – after all, you paid for it.

  4. Neil Caffrey says:

    People always think that rich people have such better access (which they do) to healthcare. But once people are being treated, I think its very difficult to see a difference in results.

  5. August says:

    “Most studies have found that the association between cost and quality is small to moderate, regardless of whether the direction is positive or negative. Future studies should focus on what types of spending are most effective in improving quality and what types of spending represent waste.”

    More science!

  6. Dorothy Calabrese, M.D. says:

    . . .the findings “suggest that the association between health care costs and quality is still poorly understood.” The actuarial premise is too general.

    One prime example where spending outrageous sums of money universally leads to better care, cheaper care and incredible outcomes is cutting-edge medical research disguised as clinical medicine.

    In 1954, the first kidney transplants between living patients -identical twins were performed at the Brigham. By physician standards this was a “cheap start” to the billions then spent progressing to stem cell Tx, other solid organ Tx and non-solid organ Tx.

    Two decades later, I went on to Columbia P & S, where only kidney and cornea transplants were routinely done.

    More than four decades after the first Brigham kidney transplant, there were too few top US lung TX centers, no studies showing that there was any significant outcome improvement with lung Tx for cystic fibrosis patients, and inevitably many, many months of inpatient recovery. A million + dollars would be racked up per patient in charges to Medicare and private insurance in the early days. . . for the lucky patient who survived long enough.

    Six decades later, CF patients go to NY Presbyterian, and other top lung Tx centers, get a lung transplant, are discharged within days with the gift of quality and quantity of life.

    The exact same multi-generational pattern of enormous investment in a few patients exists in the quantum leaps we have seen in neonatology.

    MILLIONS of dollars seem “unjustifiably” wasted on individual patients who are guaranteed NOTHING in the “pioneer” phases of clinical medicine.

    Is it clinical research pretending to be EBM clinical care to gobble up insurance monies rather than require grants of real research dollars from government and the private sector?

    Isn’t a bureaucrat justified in stamping “medically unnecessary” all over any one of those individual pioneer cases?

    Is it what differentiates we as committed physicians who live to push the bar forward from being relegated to a lifetime of “cookie cutter” medicine?

    Is it the best investment we, as physicians, ever make in clinical research?

    Is it not what differentiates American medicine from minimalistic single-payer systems in other countries?

    Does it not sanctify life and define who we are as Americans?

    Dorothy Calabrese, M.D.
    Allergy & Immunology San Clemente, CA

  7. Jordan says:

    +1 Dr. Calabrese