Higher spending on hospital care is linked to lower death rates, according to new research analyzing a decade of cost and quality outcomes for more than 2.5 million patients at 208 California hospitals.
The study, published Feb. 1 in Annals of Internal Medicine, is the largest yet to apparently contradict well-known research published as part of the Dartmouth Atlas of Health Care. The atlas researchers have found wide regional variations in care costs without corresponding increases in quality outcomes, including mortality rates. Sixty percent more care in the highest-spending regions due to hospitalizations, physician visits, diagnostic imaging and other interventions had little apparent effect on mortality outcomes or other quality metrics for Medicare patients, Dartmouth researchers have concluded.
But in the new study, California hospitals that spent more had lower in-hospital mortality rates for Medicare patients with six common deadly conditions such as congestive heart failure and pneumonia. For example, heart attack patients at the lowest-spending quintile of hospitals from 2004 to 2008 were 19% less likely to survive their stay than counterparts at the highest-spending hospitals. The average cost of hospital care for such patients was $21,072, four times greater than at the lowest-spending hospitals.
“We’re sort of taking on the view that more [health care spending] is actually worse — that more is less,” said John A. Romley, PhD, the study’s lead author. “We’re just saying, in this context, more is more.”
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