Is More Care Better Care?
We previously reported that although aggressive treatments add to costs they also may produce better outcomes, contrary to conventional wisdom. Austin Frakt draws our attention to three more studies:
- Elderly patients who received surgery in hospitals known for aggressive treatment shows significantly reduced mortality and failure to resuscitate.
- Traveling patients who became ill while visiting regions characterized by high-medical spending had lower mortality rates than similar patients who became ill visiting a low-spending areas.
- Higher-use hospital regions produced better outcomes for heart attack patients for the patients where surgery is most appropriate.
Maybe the question should be, “Is better care better care?”
Medical ethicists, public health advocates, medical experts and advocates for the elderly would like to identify the precise boundary where care beyond a discrete limit provides no additional benefit. That’s almost like counting the number of angels that can dance on the head of a pin. At its core, the argument is really about rationing. What they are really trying to assess is at what point is more care is too much care? What amount of benefit is too little benefit for the expenditure? How much can society afford to spend on a predetermined benefits?
Goes against the received wisdom. But the received wisdom may be wrong.
I wonder whether any of these studies controlled for income — the income of the area where the care was given (high spending areas and hospital use) and the income of patients (elderly treated aggressively), since disparities in treatment outcomes tend to track income.
As several people pointed out the last time this issue came up, you have to be really inefficent for there to be no relationship between inputs and outputs. In these cases, there apparently is a relationship, but there still could be a lot of inefficiency.
My 80+ year old neighbor has pancreatic cancer. Under normal circumstances, he said they would try to make him as comfortable as possible, but not really treat the cancer. But because he is unusually healthy, they asked him to consider undergoing surgery and follow-up treatment. They want to see how an elderly man reacts to the radical cancer treatment they would use on a younger man.