The relationship between health care spending and quality of
care is "totally unclear," say researchers in a Reuters Health article
about their meta-analysis of 61 studies that compared health care spending with
outcomes on both small hospital-wide scales and broader state-wide levels.
Some of the studies looked at whether hospitals that spent more money per patient had fewer in-hospital deaths,
or if their physicians and nurses better followed guidelines. Others compared
states' Medicare spending with how well their older residents were treated for
a range of conditions.
"The bottom line was that no matter how you drill down into the
results, at every level the results are just all over the map," Peter S. Hussey, PhD, the study's lead investigator, told
Twenty-one of the 61 studies showed higher spending was tied to better
outcomes for patients, such as fewer deaths. However, 18 studies found a link
between more spending and worse outcomes, and 22 showed no difference or an
unclear association based on spending.
Many of the studies compared certain types of spending with potentially
unrelated outcomes. Others didn't take into account how sick patients were
initially when looking at how they fared in different situations, the article
Hussey and colleagues
conclude that future studies should focus on what types of spending are
most effective in improving quality and what types of spending represent waste.
The findings are published in the January 1 issue of Annals of Internal Medicine.