Re: More Medicine Is Not Better Medicine

"Founding Father" <[EMAIL PROTECTED]> wrote in message news:<[EMAIL PROTECTED]>...
> By ELLIOTT S. FISHER
> 
> HANOVER, N.H. ? No one in Washington is completely satisfied with the
> Medicare legislation that Congress approved last week. For many
> conservatives, the shift toward private health plans is too limited; for
> many liberals, the new prescription-drug benefit is too stingy. Yet almost
> everyone agrees that the current bill worsens the program's long-term
> financial stability.
> 
> Constructive debate about Medicare's costs, however, is hampered by a flawed
> assumption that both helps and is reinforced by the health care industry:
> that more care ? and more expensive care ? is better care.
> 
> 
> The difference in spending is almost entirely due to the way medicine is
> practiced in high-cost regions. Compared with similar patients in Portland,
> Medicare enrollees in Manhattan spent more than twice as much time in the
> hospital and had twice as many doctor visits per year. The additional
> services provided in higher spending regions are largely discretionary, like
> more frequent visits to specialists, longer hospital stays and more frequent
> use of diagnostic tests and minor procedures. Remarkably, more spending does
> not lead to more people receiving expensive and proven treatments, like
> cardiac bypass surgery or hip replacement.
> 
> 
> What was surprising is that quality was actually somewhat worse in regions
> that provided more care, with less frequent use of proven treatments for
> heart attack patients and of preventive services. Meanwhile, access to care
> and satisfaction were worse or no better than in regions that provided less
> care
> 
> 
> Better information will allow us to get the incentives right. The backlash
> against "managed care," which was evident in the Congressional debate over
> Medicare, has been driven largely by the fear that beneficial treatments
> were being denied because doctors were paid more to provide less. But
> unmanaged care and unfettered growth can also be dangerous. If health care
> organizations were held accountable for improving the quality and efficiency
> of care, patients might believe that excellent care and lower costs are
> compatible.
> 
> 
> Our study suggests that perhaps a third of medical spending is now devoted
> to services that don't appear to improve health or the quality of care ? and
> may make things worse. It also shows that we have sufficient current
> capacity to cover the uninsured ? without necessarily increasing spending.
> (All that would happen is that the well-insured would see their doctors less
> often and, perhaps to their benefit, spend less time in the hospital.)
> 
> Members of Congress are right to be concerned about increases in federal
> spending. The debate over Medicare underscores the challenge: how to pay for
> better care, not just more care.
> 
> 
> Elliott S. Fisher is professor of medicine at Dartmouth.


It's true that "more" doesn't mean better. Unnecessary high-tech
tests, overmedication (much of it due to overmarketing by
pharmaceutical companies), and more emphasis on invasive and expensive
interventions late in deisease than on early preventative care -- all
these are examples of more being worse, and all are encouraged by our
market-driven health care system.