Does Higher Health Care Spending Lead To Better Patient Outcomes?

First time accepted submitter ericjones12398 writes "If you haven't seen the words 'health care' in news headlines lately, you must be living under a rock. What seems most controversial among the latest research and news is a flawed payment scale that undervalues primary care and overvalues specialty care. There is evidence suggesting that publicly funded health care spending (i.e., Medicare) has not been based on primary health care needs. Rather, In the U.S. Medicare spending relies on a resource-based relative value scale (RBRVS) which seems to promote higher spending without evidence of better patient outcomes. A study comparing spending and mortality rates in Ontario had the opposite findings however, supporting a link between higher spending and better outcomes for patients. What are we doing different in the U.S.? "

Comments

Re:We all know why

[jjohnson]

And when you don't directly have to pay for it (ie Medicare) then you don't care about the cost to benefit.

This isn't true in UHC countries like Canada or France or Sweden, so why would it be true in the U.S.? In UHC countries, annual per capita spending is around 55% of what it is in the U.S. (in 2010, $3,900 to $7,400), and they have better aggregate outcomes as measured by things like life expectancy (average 2+ years higher in UHC countries than in the U.S.). With UHC schemes, it looks pretty clearly like they pay less and get more effective medical treatment.

Re:We all know why

[jjohnson]

Because across a whole population, you would expect that the sum total of benefits of things like exercise, good medical care, healthy lifestyle choices, etc. would show up in life expectancy. When you have two populations, like Canada and the U.S., who have pretty comparable lifestyles overall, it seems like a reasonable, if blunt, proxy for the overall quality of health care.

In the case of Canada and the U.S. at least, more on-point aggregate measures show the same thing: Canadians as a whole get better health care than Americans, and seem to have less trouble making appropriate cost/benefit tradeoffs in their health care.

Re:We all know why

[CptPicard]

Well, I'm a Finn, so we count as a "Socialist medicine" country, and as a somewhat severely disabled person by birth who still has been patched up to be a happy taxpayer, I certainly count as a huge and probably never fully profitable beneficiary of our system, but anyway...

I frankly do not believe in the "UHC people do not care about the cost to benefit" argument. At least in civilized countries, people will have some common sense that even when they might totally destroy their health, it's not going to be fun even though they might get healthcare in the end. You'll want to avoid getting an organ transplant in general even though it might be paid for. When there are obvious public health concerns, such as the generally excessive alcohol intake in Finland, educating the public is a relatively small "totalitarian" cost as the objective benefit is so easy to see. Pure Libertarians will of course always disagree, and I can appreciate that.

The benefit of general social insurance not only in economic but ethical terms just outweighs any abuse concerns. Those who would, really deserve the pain that comes with the unfortunately necessary pain that comes with the condition they put themselves into, regardless of the healthcare they're getting.

And when it comes to actually *how* to provide the healthcare, it's all actually mercifully objective -- it's not like buying a car. Medicine is a science. We know that certain treatments work, in a scientific sense, and others do not. Hospitals do not need to be hotels. During my lifetime, I've been treated by incredibly skilled and compassionate public-sector doctors and nurses who have done their best -- and yet I've always been glad to be out of the hospital, as that means I'm getting better. And the outcome has been pretty good so far, yet I'm not so sure after all the cuts that are being imposed at the moment. Even the public sector can't run on thin air :-)