We’ve seen this before: a study showing large聽spending disparities to treat similar ailments and little if any link between expenditure and effectiveness.聽What’s different about this analysis is the patients.聽Many聽reports聽on cost and quality disparity (the best known is the ) are based on data from the government’s Medicare program for seniors. , published聽in the September issue of Health Affairs,聽focuses on care provided by nearly 250,000 physicians treating non-elderly UnitedHealthcare patients from 2006 through part of 2009.
Some of the cost gaps聽are shocking. For treating a basic asthma episode, cases in the 10th percentile of distribution cost聽$98 each while in the 90th percentile the cost was聽$1,535 per case. As usual, the study’s authors, all of whom work for UnitedHealthcare or a sister company, attempted to adjust for case severity. That means you can’t explain the聽difference by saying聽expensive patients were 15 times sicker than the聽cheap ones.
Migraine sufferers in the 10th percentile got聽treated for $94 while those in the 90th percentile cost the system $2,006.聽Expense for treating聽high blood pressure ran from $149 to $1,469 per episode.
The cost disparity for major procedures was smaller. But the聽dollars were larger. Bills for implanting a drug-coated coronary artery stent were $16,092 in the 10th percentile and $36,487 in the 90th — more than twice as much.聽Uncomplicated baby deliveries ranged from $6,149 to $12,090.
Like previous studies based on Medicare claims, the study also found wide variation in costs in different geographical areas. But聽bigger price tags聽didn’t buy better outcomes. “We found essentially no correlation between average costs and the measured level of care quality across markets,” the authors wrote.
The聽researchers studied doctors who had already been identified聽as providing higher-quality care, demonstrating large variability even within that group.聽However, a subset聽receiving good scores for both quality and efficiency delivered care costing about 14 percent less compared with that of other physicians.
The authors’ conclusion: “Changing incentives through payment reforms could help to improve performance, but providers are at different stages of readiness for such reforms.”
Translation: The medical value equation is still far from being solved.
