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Spending not linked with decline in mortality rates

by Brendon Nafziger, DOTmed News Associate Editor | August 16, 2010
Study examines how much
'bang' we get for
our health care bucks
Spending is not linked with big drops in mortality rates from common conditions, according to a study published in the August edition of Health Affairs.

Although mortality rates were falling across most of the seven conditions examined, the amount of money spent to achieve these gains varied widely, with some conditions, such as sepsis, virtual black holes of spending - receiving lots of money but with little to show for it.

"We've never paid attention as a society to the value that we're getting in health care, and that's really one of the messages of this study, to say, we should be looking at value, and not just cost," Dr. Michael B. Rothberg, associate professor of medicine at Tufts University School of Medicine in Boston, and Baystate Medical Center in Springfield, Mass., told DOTmed News.
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Unlike most consumer goods, where costs hold steady or are falling, costs in medicine keep rising, according to the paper. There are two hypotheses, Rothberg said: are patients getting more care, or is the same care just costing more?

"It's probably a combination of both," he said. "We know the costs of providing the same care are going up, because [the costs of] all the components are going up."

Rothberg got involved in the research as he noticed over the years a 20 percent reduction in mortality from pneumonia. Although significant, it might not be visible to providers, he said, as the reduction translates into mortality rates of 4 out of 100, down from about 5 out of 100. He was thinking of ways of sharing this information, when he wondered what was spent to achieve that drop in mortality.

In the study, Rothberg and his team measured seven common diagnoses at 122 U.S. hospitals from 2000 to 2004, using inpatient data hospitals report to the Healthcare Cost and Utilization Project.

These included heart attack, chronic obstructive pulmonary disease, pneumonia, congestive heart failure, stroke, sepsis and urinary tract infection.

For all except sepsis, mortality dropped steadily.

Three of these, heart failure, heart attacks and pneumonia, had the biggest relative declines in mortality, with 21, 19 and 20 percent declines, respectively. They were also the diseases targeted by quality improvement campaigns - in 2001, the Joint Commission introduced "core measures" of quality for these conditions.

But money spent on the conditions did not reflect the size of the relative drop in mortality. Pneumonia, which had a 20 percent decline in mortality, witnessed a 26 percent increase in spending, or about $1,619 more per patient, in 2004 dollars. Heart failure, which saw death rates drop 19 percent, experienced the biggest cost increase, up 60 percent, or an additional $3,452 per patient in 2004 dollars.