No evidence that higher regional health care costs indicate inappropriate care, study shows

March 20, 2012

There is no solid evidence to support the widely held belief that regions of the United States that spend more on health care and have higher rates of health care use deliver more unnecessary care to patients, or that low-cost areas deliver higher quality and more efficient care, according to a study led by Salomeh Keyhani, MD, a physician at the San Francisco VA Medical Center and an assistant professor of medicine at the University of California, San Francisco.

The study authors called for policies designed to discourage inappropriate care, regardless of region.

"Geographic variations in have captured the attention of researchers for the past 30 years, especially during the recent debate," said Keyhani. "The assumption is that areas that spend more are delivering more inappropriate care in the form of unnecessary tests and procedures." In turn, she said, "this has led policy makers to hold up low-cost areas as models of high-quality health care, and to propose policies that cap spending."

That assumption is unwarranted, according to Keyhani and her co-authors. "The literature is so limited that you cannot either support or refute such an assertion. There is just not enough data," said Keyhani.

In their study, the scientists reviewed 114,830 peer-reviewed articles, published between January 1, 1978 and January 1, 2009. They found only five that analyzed detailed clinical data in relation to geographic region, and concluded that the results of those papers "did not lend support" to the idea that higher cost regions deliver more inappropriate care. Their literature review was published in the March issue of the journal .

"Do we have any evidence to say that the differences in cost of care in different localities are actually related to inappropriate care? No," asserted Keyhani.

She concluded that "instead of focusing on geographic variations, more of our efforts should be directed at designing policies that will reduce inappropriate care in general, regardless of region."

However, said Keyhani, "you need good scientific evidence to design such policies, and right now, that evidence is lacking." In a related literature review based on the same 30-year data base, published on January 23 in the Archives of Internal Medicine, Keyhani and her colleagues found only 172 peer-reviewed articles that addressed the general topic of health care overuse.

One reason for the dearth of such literature, Keyhani said, is an overall lack of patient care guidelines by which researchers might judge overuse of tests and procedures: "There are not enough guidelines, and most of those that do exist don't address inappropriate care. Guidelines state when you should give a diagnostic test, for example, but they don't say when you shouldn't. And if you have no standards, how can you say when care is inappropriate?"

Creating guidelines is "expensive and very labor intensive," acknowledged Keyhani. "And it's not something one health system can do by itself. There needs to be a national investment."

Nonetheless, she said, the long-term benefits of such guidelines for the U.S. health care system would be considerable. "Overuse isn't just a matter of unnecessary expense, but of patient safety," she noted. "People assume that more care is better. In fact, we know that unwarranted procedures can add to health risks and lead to poor outcomes."

Explore further: Study examines research on overuse of health care services

Related Stories

Study examines research on overuse of health care services

January 23, 2012
The overuse of health care services in the United States appears to be an understudied problem with research literature limited to a few services and rates of overuse varying widely, according to an article published in the ...

Quality health care delivery key election issue, says CMAJ

April 6, 2011
Delivering quality health care rather than health care sustainability is a key issue for Canada's federal election, and Canadians need a vision from federal leaders to radically transform our health care system, states an ...

Low levels of care-seeking for newborn illness in low- and middle-income countries

March 7, 2012
In this week's PLoS Medicine, Abdullah Baqui from the Johns Hopkins Bloomberg School of Public Health, USA and colleagues systematically review studies describing newborn care-seeking behaviours by caregivers in low- and ...

Recommended for you

Amber-tinted glasses may provide relief for insomnia

December 15, 2017
How do you unwind before bedtime? If your answer involves Facebook and Netflix, you are actively reducing your chance of a good night's sleep. And you are not alone: 90 percent of Americans use light-emitting electronic devices, ...

Warning labels can help reduce soda consumption and obesity, new study suggests

December 15, 2017
Labels that warn people about the risks of drinking soda and other sugar-sweetened beverages can lower obesity and overweight prevalence, suggests a new Johns Hopkins Bloomberg School of Public Health study.

Office work can be a pain in the neck

December 15, 2017
Neck pain is a common condition among office workers, but regular workplace exercises can prevent and reduce it, a University of Queensland study has found.

Regular takeaways linked to kids' heart disease and diabetes risk factors

December 14, 2017
Kids who regularly eat take-away meals may be boosting their risk factors for heart disease and diabetes, suggests research published online in the Archives of Disease in Childhood.

Simulation model finds Cure Violence program and targeted policing curb urban violence

December 14, 2017
When communities and police work together to deter urban violence, they can achieve better outcomes with fewer resources than when each works in isolation, a simulation model created by researchers at the UC Davis Violence ...

Your pets can't put your aging on 'paws'

December 14, 2017
(HealthDay)—In a finding that's sure to ruffle some fur and feathers, scientists report that having a pet doesn't fend off age-related declines in physical or mental health.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.