Showing posts with label economics. Show all posts
Showing posts with label economics. Show all posts
Tuesday, April 03, 2012
media: (U.S.) Higher-Spending Hospitals Have Fewer Deaths for Emergency Patients
Blogger's Note: a similar report from Canada was posted recently (eg. higher spending hospitals)
Higher-Spending Hospitals Have Fewer Deaths for Emergency Patients
Tuesday, March 13, 2012
Bloomberg News: Canadian Hospitals That Spend More on Patients Get More - Businessweek
Canadian Hospitals That Spend More on Patients Get More - Businessweek
Bloomberg News
Canadian Hospitals That Spend More on Patients Get More
Canadian hospitals that spent the
most on patient care may be getting a bigger bang for their buck
than their U.S. counterparts, researchers suggested.
A study reported today in the Journal of the American
Medical Association compared patient results between Canadian
hospitals that spent more on care, and those that spent less. It
found patients in the first category had lower death rates and
were less likely to be admitted to intensive care. Research on the U.S. health-care system, however, has shown that higher spending at hospital systems doesn’t guarantee better results, according to the study’s author, Therese Stukel.
“When we spend more, and when we place these specialized resources, we’re doing it in an efficient way,” said Stukel, a senior scientist at the Institute for Clinical Evaluative Sciences in Toronto, in a telephone interview. “That’s in contrast to the U.S.”
Under Canada’s system of universal health care, patients at high-spend hospitals had longer lengths of stay and more specialist visits, the study found. That’s because the health plan in Canada, where per capita health expenditures are 57 percent of those in the U.S., better allocates expensive specialists and technology, Stukel said.
While the U.S. has a 3- to 4-times higher per capita supply of expensive, specialized technology, such as MRIs, it has a similar supply of hospital beds and nurses as Canadian hospitals, according to the study.
Dartmouth Atlas
The Canadian findings may help to better understand studies such as the Dartmouth Atlas of Healthcare, a 20-year research project that has documented variations in how medical resources are distributed in the U.S. The data has shown that the parts of the country that spent the most per patient have worse patient outcomes than low-spending areas.Today’s study “breaks through the generalization,” that all spending is bad, said David Goodwin, co-principal investigator at the Dartmouth Atlas, in a telephone interview. “It’s important that we look at spending in the aggregate and where more is better, and where more is worse.”
The U.S. health-care law signed in 2010 has several components designed to slow spending and have U.S. hospitals emulate the coordinated care of their Canadian brethren. Those measures haven’t been without controversy. Republicans are seeking to repeal the law’s Independent Payment Advisory Board, which will cut Medicare rates with limited oversight from lawmakers.
The law’s Accountable Care Organizations have Medicare pay hospitals bonuses when they coordinate to provide better care and save money. Health systems are penalized if they overspend or produce worse outcomes.
Misinterpreting Dartmouth
In an editorial accompanying the research, Karen Joynt and Ashish Jha, researchers at the Harvard School of Public Health, said some policymakers have drawn wrong conclusions from the Dartmouth data.“What Dartmouth investigators have documented through careful work is that dysfunctional systems produce expensive, poor-quality care,” Joynt and Jha wrote.
Stukel’s Canadian study examined nearly 400,000 cases of heart attack, heart failure, hip fracture and colon cancer in Ontario hospitals over 10 years, looking at whether the patients died or were readmitted.
The most expensive Canadian hospitals in the study spent about twice as much per patient than their lower-spending counterparts. For every condition the study looked at, patients died less often and were readmitted less often at the more expensive hospitals.
Expensive Hospitals
Those more expensive hospitals had something else in common -- they were often academic hospitals, or community hospitals that saw more patients than others, they had cancer centers attached, lots of specialists on staff, performed more advanced procedures, had more technology and nurses that spent more time with patients. Patients were also more likely to get a follow-up visit within a year and get more intensive discharge care.That’s not to say that putting more money into lower- spending Canadian hospitals would produce better care there.
“It would be facile to interpret this study as demonstrating that higher spending is causally related to better outcomes and providing more money to lower spending hospitals would necessarily improve their outcomes,” Stukel and her co- authors said in the study.
Instead, it’s better care coordination and spending on the right types of care that improve outcomes, as well as limited budgets on overall spending, Stukel said.
Coordinated Systems
Stukel said she doesn’t advocate a Canadian-style system of universal coverage in the U.S. She said that coordinated U.S. managed care systems, like Kaiser Permanente in California, Intermountain Healthcare in Salt Lake City, and Geisinger Health System in Pennsylvania are models the rest of the country emulate.She predicts that Canadian hospitals will likely use her study to ask the government there for more money, even though that’s not the point of her research.
“If we put more dollars into the acute care system, it
might still improve, it might peak,” she said. “It’s not just
putting money into the system, it’s where we spend it.”
Editorial: The Relationship Between Cost and Quality, No Free Lunch - March 14, 2012 — JAMA + link to original article
The Relationship Between Cost and Quality, March 14, 2012, Joynt and Jha 307 (10): 1082 — JAMA
Editorial: The Relationship Between Cost and Quality
No Free Lunch
Since this article does not have an abstract, we have provided the first 150 words of the full text. (Blogger's Note: subscription required to view $$$)
"For the past 30 years, research from
investigators at Dartmouth has demonstrated large and persistent
variations in costs
and quality across the US health care system. Beyond
simply showing that cost and quality vary by geography, the Dartmouth
Atlas has demonstrated that in many communities, care
is so fragmented and ineffective that greater spending on Medicare
beneficiaries
often leads to worse outcomes1,2 because some patients receive services that are redundant and low value and that may even have substantial risks.
However, some US policy makers have
misinterpreted the Dartmouth research and in the troves of data have
found what they believe
to be a free lunch: given the inverse relationship
between costs and quality, it follows that it should be possible to
simultaneously
reduce spending and improve care. Although this notion
is attractive, much of the subtlety of the Dartmouth work has been
lost in translation. What ....."
Tuesday, February 07, 2012
Saturday, May 28, 2011
abstract: Cost-effectiveness of combination versus sequential docetaxel and carboplatin for the treatment of platinum-sensitive, recurrent ovarian cancer
CONCLUSIONS:
Combined weekly cDC (concurrent docetaxel and carboplatin) appeared to
be cost-effective compared with sDC (sequential docetaxel and carboplatin ) as treatment strategy for patients
with platinum-sensitive ovarian cancer, even when accounting for
slightly lower QoL during treatment.
Wednesday, August 11, 2010
AACR Hosts Cancer Disparities Conference in Miami, Fla. abstract online Sept
This year, the American Association for Cancer Research will host its third conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved at the Loews Miami Beach Hotel in Miami, Fla.
Findings presented at this year’s meeting will include:
• proven communication methods for reaching minority populations;
• strategies to increase enrollment in clinical trials;
• prognosis in lung cancer affected by race;
• breast cancer trends in Arab and Israeli Jewish women;
• the importance of social support and physical activity in survivors; and,
• socioeconomics and access to health care.
To help you plan your coverage of the conference, the program schedule is available online at
http://www.aacr.org/disparities2010
abstracts will be available on Sept. 22, 2010
Subscribe to:
Posts
(
Atom
)
