Health Affairs
April 7, 2004
Medicare Spending, The Physician Workforce, And Beneficiaries’ Quality Of Care
By Katherine Baicker and Amitabh Chandra
Abstract:
The quality of care received by Medicare beneficiaries varies across areas. We find that states with higher Medicare spending have lower-quality care. This negative relationship may be driven by the use of intensive, costly care that crowds out the use of more effective care. One mechanism for this trade-off may be the mix of the provider workforce: States with more general practitioners use more effective care and have lower spending, while those with more specialists have higher costs and lower quality. Improving the quality of beneficiaries’ care could be accomplished with more effective use of existing dollars.
http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.184v1/DC1
Comment: Some will surely react in disbelief to the fact that “the greatest health care system on earth,” with its technologically-advanced, highly-specialized services, actually delivers lower-quality care when there is increased utilization of those high-tech, highly-specialized services. Though it is true, it represents not so much of an indictment of high-tech medicine as it is an indictment of our failure to adequately support a strong primary care base.
Primary care physicians deliver care at a lower cost primarily because they do not use as much expensive, high-tech interventions as do specialists practicing within their own field. But the long-term relationship between the primary care physician and his or her patient occurs within an environment that is more than conducive to lending attention to broader interventions that are well documented to improve outcomes. Scheduling a routine, screening mammogram is an impotent function of primary care physicians, but would not normally be part of the role description of a general surgeon, or certainly not of an ophthalmologist. The primary care fields are board-certified specialties for a very good reason. Primary care specialists specialize in primary care, providing important, beneficial services that are not provided by high-tech specialists.
We clearly need to improve the way in which we allocate our health care funds. Our current system is profit oriented. Physicians will understandably factor in profit potential as they choose their specialties. Access to health care funds should have a positive correlation with quality. But that will never happen under our current fragmented system of funding care.
Only with an integrated approach within a universal system will we be able to improve resource allocation. Such improvement should inevitably include generous funding of a strong primary care base. That would certainly move us closer to our goal of affordable, high quality care for all of us.