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Spending Doesn't Improve Patients' Perception of Care

Sense of quality higher in low-expenditure areas than in high-expenditure ones, study shows

TUESDAY, May 27 (HealthDay News) -- Higher levels of spending on medical care don't improve patients' perceptions of the care they receive, according to researchers who conducted a survey of Medicare beneficiaries.

Per capita spending on Medicare beneficiaries varies widely across the United States and differences in health don't account for this variations, said the study authors, who added that little is known about whether beneficiaries in high-expenditure areas receive better care than those in low-expenditure areas.

The University of Massachusetts researchers surveyed 2,515 Medicare beneficiaries about their perceptions of health-care quality and compared their answers to per capita spending in various regions across the United States.

There was a strong link between per capita spending and receiving more medical care, such as average number of ambulatory visits to physicians in the past year and more cardiac tests -- 63.5 percent of patients in regions with the highest per capita spending reported having tests, compared with 40.1 percent of those in regions with the lowest per capita spending.

However, seven of the 10 measures of patients' perception of health care quality -- such as unmet needs for tests and treatment, and spending enough time with doctors -- were unrelated to expenditures, said the study.

It also found the overall rating of perceived quality of care was higher in the lower-expenditure areas (63.3 percent reported an overall care rating of 9 or 10) than in higher expenditure areas (55.4 percent).

"On average, those in the lower-expenditure areas reported no more perceived unmet needs for care and a perceived quality of ambulatory care similar to that in high-expenditure areas; furthermore, they rated the overall quality of their health care at least as highly as those in the high-expenditure areas," the researchers wrote.

The study is published in the May 28 issue of the Journal of the American Medical Association.

The findings contribute "to the discussion concerning whether the economic principles of 'more is better,' diminishing returns, and comparisons to others apply in health care," Gerard F. Anderson and Kalipso Chalkidou, of the Johns Hopkins Bloomberg School of Public Health, wrote in an accompanying editorial.

"When patients are able to access good-quality objective information on the risks and benefits of the various treatment alternatives, they do not necessarily choose more aggressive or more costly interventions. Currently, the United States spends more than twice as much as most other industrialized countries on health-care services, some regions of the United States spend twice as much as other regions of the country, and some institutions or clinicians are twice as expensive as others. In terms of outcomes and satisfaction, the United States may have reached the position of diminishing returns for spending on medical care."

More information

The U.S. Agency for Healthcare Research and Quality has more about health care quality.

-- Robert Preidt

SOURCE: Journal of the American Medical Association, news release, May 27, 2008

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