Seniors Happy with Medical Care Regardless of
How Much Medicare Spends on Them
Spending varies widely but perceptions of medical
care quality does not
May 27, 2008 Many senior citizens would be
surprised by the wide differences in per capita expenditures by Medicare
from area to area across the U.S. A new study has found, however, that
those Medicare beneficiaries in the lowest expenditure areas are just as
happy if not more so with their medical care as are those in the
high expenditures areas.
The survey of Medicare beneficiaries suggests that
more regional spending on medical care does not improve patients
perceptions of the medical care they receive, according to a report in
the May 28 issue of the Journal of the American Medical Association (JAMA).
It is well documented that per capita expenditures
by Medicare vary widely across the country, and that differences in
health status do not account for these variations. These researchers,
however, found little is known about whether beneficiaries residing in
low-expenditure regions perceive receiving lower-quality of care than
those in high-expenditure regions.
Floyd J. Fowler Jr., Ph.D., of the University of
Massachusetts Boston, and colleagues report results of a detailed survey
of Medicare patients which included a number of questions about the
perceptions of quality of health care from the patients own
perspectives. The researchers compared these answers with the overall
level of per capita expenditure within various regions in the U.S., to
evaluate whether more spending leads to a more positive patient
experience with the health care system.
Each respondent (answers from 2,515 patients were
used for this study) was allocated to one of five quintiles, depending
on sex, average age, and race-adjusted per capita Medicare expenditures
based on Centers for Medicare & Medicaid Services claims data.
The survey included three questions about perceived
unmet need for care, four questions about the perceived quality of
ambulatory care and three questions rating the perceived quality of
overall care.
The researchers found that per capita expenditures
were highly related to receiving more medical care, such as average
number of ambulatory visits to physicians in the past year and more
cardiac tests (respondents reporting receiving tests in past year, 40.1
percent in the lowest average expenditures quintile, to 63.5 percent in
the highest average expenditures quintile).
However, 7 of the 10 measures of perceived quality,
including perceived unmet needs for tests and treatment (respondents
reporting unmet needs, 3.9 percent to 5.0 percent) and spending enough
time with physicians (respondents reporting adequate time, 88.7 percent
to 87.0 percent), were unrelated to expenditures.
The overall rating of perceived quality of care,
however, was higher in the lower-expenditure areas (respondents
reporting overall care rating of 9 or 10, 63.3 percent to 55.4 percent).
On average, those in the lower-expenditure areas
reported no more perceived unmet needs for care and a perceived quality
of ambulatory care similar to that in high-expenditure areas;
furthermore, they rated the overall quality of their health care at
least as highly as those in the high-expenditure areas, the authors
write.
Editorial: Spending on medical care - more is
better?
The article by Fowler et al adds to the discussion
concerning whether the economic principles of more is better,
diminishing returns, and comparisons with others apply in health care,
write Gerard F. Anderson, Ph.D., and Kalipso Chalkidou, M.D., Ph.D., of
the Johns Hopkins Bloomberg School of Public Health, Baltimore, in an
accompanying editorial.
When patients are able to access good-quality
objective information on the risks and benefits of the various treatment
alternatives, they do not necessarily choose more aggressive or more
costly interventions.
Currently, the United States spends more than
twice as much as most other industrialized countries on health care
services, some regions of the United States spend twice as much as other
regions of the country, and some institutions or clinicians are twice as
expensive as others.
In terms of outcomes and satisfaction, the United
States may have reached the position of diminishing returns for spending
on medical care.
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May 27, 2008 Many senior citizens would be
surprised by the wide differences in per capita expenditures by Medicare
from area to area across the U.S. A new study has found, however, that
those Medicare beneficiaries in the lowest expenditure areas are just as
happy if not more so with their medical care as are those in the
high expenditures areas.