Money can buy better health, study finds -- if you’re a hospital patient
When it comes to heart attacks, strokes and some other types of medical emergencies that could land you in the hospital, you get what you pay for.
So says a group of researchers from USC and Harvard Medical School. It looked at data on more than 2.5 million patients who were hospitalized over a 10-year period for six common conditions and concluded that the patients who were treated in high-spending hospitals were less likely to die in the hospital than the patients who went to low-spending hospitals.
To figure this out, the researchers gathered cost data from 208 California hospitals and divided the facilities into five tiers based on spending patterns. Then they zeroed in on six health problems that accounted for at least 10% of all hospital admissions between 1999 and 2008, the period studied. In addition to heart attacks and strokes, these included congestive heart failure, pneumonia, hip fractures and gastrointestinal hemorrhages.
The first thing worth noting is the huge variation in spending per patient. For example, between 2004 and 2008, the amount spent on patients who suffered heart attacks was about $5,168 for the hospitals in the bottom tier and $21,072 for hospitals in the top tier. For patients with GI hemorrhages, the tab was about $4,859 among hospitals in the bottom tier and $21,762 among hospitals in the top tier. To treat patients with pneumonia, the lowest-spending hospitals spent about $5,556 per patient and the highest-spending hospitals spent about $20,789 per patient. You get the idea. (The figures were based on costs to treat patients who died while they were in the hospital, so they aren’t a true average of expenditures for all patients.)
So what did all that extra money buy?
In the case of heart attacks, patients treated at the “expensive” hospitals were 14% less likely to die in the hospital than their counterparts in the “cheap” hospitals between 1999 and 2003, and 26% less likely to die between 2004 and 2008. Pneumonia patients in the top-spending hospitals were 27% less likely to die over the entire period studied than their counterparts in the low-spending hospitals.
In fact, extra spending was almost always associated with better patient outcomes. The only exceptions were for patients hospitalized with hip fractures, and for patients with GI hemorrhages, but only between 1999 and 2003 (between 2004 and 2008, the bigger outlays made a difference).
The results appear to be at odds with studies that have examined medical spending and patient outcomes in different regions of the country and found that more money doesn’t buy better health. But the researchers noted that their results may show that certain kinds of acute-care spending are worthwhile. Unfortunately, there weren’t enough data to identify the specific interventions that made the difference, but they speculated that the list would include “early and more frequent coronary revascularization” for heart attack patients and “upper and lower endoscopies” for patients with GI hemorrhages.
The study was published inTuesday’s edition of the Annals of Internal Medicine. It was funded by the National Institute of Aging and the Rand Health Bing Center for Health Economics.
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