Why Do People Care about Healthcare Reform?

Higher Cost, not Higher Quality

Higher healthcare spending does not mean higher quality healthcare.

Although paying more for some things means you get higher quality products or services, higher healthcare spending does not lead to higher quality medical care. There are many reasons for the high healthcare costs in America, but one of them is not that we pay more to get higher quality. In fact, studies done over the past 25 years have shown that areas of the U.S. that spend more on healthcare have no better, and sometimes worse, health outcomes than areas that spend less.

Sometimes, the reason for higher costs is that the population is older or sicker. But when very similar populations are compared, there are still large variations in spending, and regions of the country spending more do not necessarily have higher quality care (Wennberg and Fisher, et al., n.d.). For example, the Medicare program spends the most per person in states with the lowest quality of care (Baicker and Chandra, 2004).

It also costs more to provide more care, but more care is not necessarily higher quality care, either. Prevention and early intervention services are often less expensive and can keep certain conditions or illnesses in check. If left untreated, these conditions or illnesses can progress to the stage where patients need more care—and more expensive care—that could have been avoided.

Sometimes patients demand more care, but often they take the advice of their doctors about what they need. Doctors and other providers, however, stand to earn more the more they do. And because our healthcare system is not well coordinated, we can see lots of doctors without any one doctor taking responsibility for the quality of all the care we receive (Gawande, 2009). Again, more care and more cost, but not higher quality.

Sources

John Wennberg, Elliott Fisher and their colleagues at Dartmouth Medical School. www.dartmouthatlas.org/.

Baicker, K. and A. Chandra. 2004 Medicare Spending, the Physician Workforce, and Beneficiaries' Quality of Care. Health Affairs Web Exclusive: W184–97. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.184

Commonwealth Fund. Performance Snapshots. www.commonwealthfund.org/Content/Performance-Snapshots/Variations-in-Care/Quality-of-Care-and-Medicare-Spending-at-the-State-Level.aspx.

Gawande, Atul. 2009. The Cost Conundrum: What a Texas Town Can Teach Us about Health Care. New Yorker, June 9. www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande.

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