In Health Care, More Is Not Always Better
Often there is an assumption that more health care means better care and better outcomes. However, there is huge variation in the amount of healthcare that similar patients receive that depends largely on where they live. For more than 20 years, the Dartmouth Atlas Project has tracked huge variations in the distribution and use of healthcare resources in the US. Studies consistently show that deploying more resources—specifically, specialist visits, diagnostic tests and hospital care, for similar patients—does not necessarily lead to better care; in fact, it could lead to harm. By safely adopting more conservative practices, the evidence suggests that savings of about 30 percent of Medicare costs or almost $40 billion, could be realized, with care that could be at least as good.
In Canada, large regional variations have been documented in the provision of healthcare for patients with conditions such as cardiac disease, stroke, arthritis, asthma and diabetes, despite the availability of evidence-based clinical guidelines.
A variety of factors, such as patient illness severity and physician clinical judgment, determine whether a patient receives more health services. But non-medical factors, including patient demand, a medical culture that promotes testing and interventions regardless of necessity, fee-for-service structures that reward volume rather than quality, and availability of health care resources, such as hospital beds and specialists, also play a role.
There are limits to the amount we can spend on health care, and there is a need to determine whether we are getting good value for our health care dollar (cost vs. benefit).