http://healthaffairs.org/blog/2009/12/10/is-more-care-better-the-evidence-suggests-no/?utm_source=rss&utm_medium=rss&utm_campaign=is-more-care-better-the-evidence-suggests-no The Policy Journal of the Health Sphere Thu, 24 May 2012 07:58:29 +0000 hourly 1 http://healthaffairs.org/blog/2009/12/10/is-more-care-better-the-evidence-suggests-no/comment-page-1/#comment-31985 bhshirts Wed, 16 Dec 2009 21:40:36 +0000 http://healthaffairs.org/blog/?p=3145#comment-31985 This article shows how statistical differences in sampling can show different results. It is unfortunate that the null hypothesis is that increased costs do not cause worse outcomes. In a health system where there are justifications for each expenditure one would expect higher costs always correlate with better outcomes. I am not surprised that at least some of the expeditures at some of the six hospitals lead to good outcomes. There is still a long way to go to show exactly which treatments provide the greatest value and which should be used selectively or eliminated to reduce unnecessary costly treatments. This article shows how statistical differences in sampling can show different results. It is unfortunate that the null hypothesis is that increased costs do not cause worse outcomes. In a health system where there are justifications for each expenditure one would expect higher costs always correlate with better outcomes. I am not surprised that at least some of the expeditures at some of the six hospitals lead to good outcomes. There is still a long way to go to show exactly which treatments provide the greatest value and which should be used selectively or eliminated to reduce unnecessary costly treatments.

]]> http://healthaffairs.org/blog/2009/12/10/is-more-care-better-the-evidence-suggests-no/comment-page-1/#comment-31925 Edward Donovan Sun, 13 Dec 2009 22:16:24 +0000 http://healthaffairs.org/blog/?p=3145#comment-31925 International studies comparing spending and outcomes suggest that U.S. variation in both these measures may be so small that it is difficult to detect a relationship if one exists. Studies that focus on this relationship only in the U.S. likely are examining one end of a larger distribution in which all spending is high and all outcomes are relatively poor. Studies that include data from countries where costs are lower and outcomes better may better test the hypothesis that higher spending for care (especially relative to spending on prevention) is associated with worse health outcomes. International studies comparing spending and outcomes suggest that U.S. variation in both these measures may be so small that it is difficult to detect a relationship if one exists. Studies that focus on this relationship only in the U.S. likely are examining one end of a larger distribution in which all spending is high and all outcomes are relatively poor. Studies that include data from countries where costs are lower and outcomes better may better test the hypothesis that higher spending for care (especially relative to spending on prevention) is associated with worse health outcomes.

]]> http://healthaffairs.org/blog/2009/12/10/is-more-care-better-the-evidence-suggests-no/comment-page-1/#comment-31924 Twitted by hctransformed Sun, 13 Dec 2009 22:10:05 +0000 http://healthaffairs.org/blog/?p=3145#comment-31924 [...] This post was Twitted by hctransformed [...] [...] This post was Twitted by hctransformed [...]

]]> http://healthaffairs.org/blog/2009/12/10/is-more-care-better-the-evidence-suggests-no/comment-page-1/#comment-31921 Potpourri of Links (Mostly Healthcare Reform Related) « humani nil a me alienum puto Sun, 13 Dec 2009 17:37:08 +0000 http://healthaffairs.org/blog/?p=3145#comment-31921 [...] of Links (Mostly Healthcare Reform Related) Health Affairs has a  blog post that integrates  recent Atlantic and New Yorker articles and challenges the wider applicability of [...] [...] of Links (Mostly Healthcare Reform Related) Health Affairs has a  blog post that integrates  recent Atlantic and New Yorker articles and challenges the wider applicability of [...]

]]> http://healthaffairs.org/blog/2009/12/10/is-more-care-better-the-evidence-suggests-no/comment-page-1/#comment-31913 mschorin Sat, 12 Dec 2009 22:40:52 +0000 http://healthaffairs.org/blog/?p=3145#comment-31913 Frankly, we have a growing problem with obesity. Just keeping people out of hospital will be a major challenge. They suffer more heart disease, diabetes, joint problems. More care may not be better...but less care cannot be a benefit either . http://schorin-strategies.com/nutrition Frankly, we have a growing problem with obesity. Just keeping people out of hospital will be a major challenge. They suffer more heart disease, diabetes, joint problems.
More care may not be better…but less care cannot be a benefit either
.
http://schorin-strategies.com/nutrition

]]> http://healthaffairs.org/blog/2009/12/10/is-more-care-better-the-evidence-suggests-no/comment-page-1/#comment-31881 barryzajac Fri, 11 Dec 2009 17:45:02 +0000 http://healthaffairs.org/blog/?p=3145#comment-31881 I look at the Ong, et al study with some reservations. The relationships that they identified are based largely on the results of one facility that had higher cost and better outcomes than the rest, which were all reasonably close together on the scatterplot. For this facility only ('F' in their analysis), approximately 32% of identified HF cases were removed from the 'looking forward' analysis due to missing cost data. No attempt was made in the article to demonstrate that this did not introduce bias into the analysis. In addition to this, I agree with the authors that generalizing from the experience of 5 facilities may not be wise in any case. I look at the Ong, et al study with some reservations. The relationships that they identified are based largely on the results of one facility that had higher cost and better outcomes than the rest, which were all reasonably close together on the scatterplot. For this facility only (‘F’ in their analysis), approximately 32% of identified HF cases were removed from the ‘looking forward’ analysis due to missing cost data. No attempt was made in the article to demonstrate that this did not introduce bias into the analysis.
In addition to this, I agree with the authors that generalizing from the experience of 5 facilities may not be wise in any case.

]]> http://healthaffairs.org/blog/2009/12/10/is-more-care-better-the-evidence-suggests-no/comment-page-1/#comment-31866 MBMundorff Fri, 11 Dec 2009 01:23:29 +0000 http://healthaffairs.org/blog/?p=3145#comment-31866 If the authors' Figure 1 is a reasonable representation of the actual data, it would appear -- despite the plotted regression line (which likely has a very low coefficient) -- that there is essentially no relationship between mortality and spending. Which would certainly at a minumum not support the assertion by Ong et al. that more spending correlates with better mortality outcomes. If the authors’ Figure 1 is a reasonable representation of the actual data, it would appear — despite the plotted regression line (which likely has a very low coefficient) — that there is essentially no relationship between mortality and spending. Which would certainly at a minumum not support the assertion by Ong et al. that more spending correlates with better mortality outcomes.

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