"People in America assume that more medical care means better medical care," says Dr. Elliott S. Fisher, a professor of medicine at Dartmouth Medical School and lead author of the study.
He and his team found otherwise. In the study, published in the Feb. 18 issue of the Annals of Internal Medicine, Fisher and his colleagues compared regional differences in per-capita Medicare spending in numerous regions across the United States and then looked at how the patients in those different areas fared.
"And one of the important points about our paper is that it is really not about spending," Fisher says.
The disparity in Medicare spending has been well known, he explains. "For 20 years we have known that residents of some regions get much more care than residents of other regions," he says, but no one could say if the regions that spend more have healthier patients.
So, using national Medicare data, his team took a look at four groups of Medicare patients -- 987,515 in all -- including some hospitalized during the years 1993-1995 for hip fractures, colon cancer and heart attacks, along with some typical patients who completed a survey.
They divided the United States into 306 regions and then down to five groups, based on spending levels. They calculated how much the programs spent during the last six months of life for those who died between mid-1994 and 1997. Then they looked at the five-year death rates for hip fractures, colon cancer and heart attacks and evaluated patient reports about satisfaction with their care and other issues.
"Residents of the regions that delivered more medical care did not have better quality of care, better access to care, or better satisfaction with care," Fisher says. The quality of care and the outcome of care in the higher-spending regions were either no better or slightly worse than the areas that spent less, he adds.
The health status of patients across all five spending levels was similar. But those who lived in the higher-spending areas did tend to go to the doctor more, have more tests, see specialists more often and get hospitalized more often, Fisher says. However, there was no evidence of lower death rates or better health status.
"Our findings suggest that up to about a third of medical care is devoted to services that do not provide any detectable benefit," Fisher says. The higher-spending areas could probably save up to 30 percent of the money they now spend. "That's not to say it would be easy to do," he quickly adds.
Fisher speculates that in areas of higher spending, the services are used more frequently simply because they are available. For instance, if a doctor is debating whether to admit a patient or follow with office visits and phone calls, he may be more likely to admit the patient if hospital beds are plentiful.
That scenario is common, adds another expert, Charles E. Phelps, a health economist and provost at the University of Rochester who wrote one of three editorials accompanying the study reports.
"There is a lot of disagreement among doctors in different parts of the country about the best say to use medical therapy," he says, "and not much scientific evidence to support one way or the other."
In his editorial, Phelps says there are still some unanswered questions, such as whether some important benefits of higher health-care spending remain unmeasured.
However, Fisher and Phelps agree the study should send an important message to patients.
"For consumers," Fisher says, "the lesson here is first to really think and ask their physician about the evidence for a specific intervention when there are major treatment choices."