Expensive medical care does not translate to better health outcome

My wife was 26 weeks pregnant with our second child when she developed lower abdominal pain. Because she was a fee-for-service Medicare beneficiary registered under a Health Maintenance Organization (HMO), she attended antenatal clinic at a big private hospital in Lagos.

As the pain worsened by the day, she was asked to do a gamut of lab investigations and scans and placed on several medications. However the pain remained unabated and the general surgeon was invited to review her.

After his clinical assessment and review of further tests and scans, the surgeon concluded she had an acute appendicitis or inflamed appendix.

What? Acute appendicitis in pregnancy? What an expensive diagnosis! I had already incurred so much on bills before they arrived at this diagnosis. I was very worried when the surgeon told me my wife would have a surgery to remove the inflamed appendix. Nevertheless, I reluctantly consented to the surgery, hoping for a good outcome for her and the baby.

The operation was successfully carried out, but when I thought the worst was over, she had a miscarriage while the abdominal pain persisted.

I had no choice but to solicit for a second opinion from another doctor in a ‘cottage ‘ hospital who just requested for urinalysis and urine culture. She was given some medications based on the urine culture results and in less than 24 hours she was better.

I was shocked that all these while, my wife had a urinary tract infection in pregnancy which wasn’t detected on time and well managed and it took just less than 48 hours to make the right diagnosis with a urine test that cost 60 times less than the total cost of tests she did in the previous grade “A” hospital! We lost the baby and still incurred inflated bills for hifalutin tests that weren’t necessary.

Also Read: Typhoid Fever and the Widal Test: Case of Misdiagnosis.

So if you think that spending more for treatment will yield better results, you are wrong.

According to research led by Harvard Medical School and the Harvard T.H. Chan School of Public Health, hospitalized patients treated by physicians who order more or more expensive tests and procedures are just as likely to be readmitted or to die as patients treated by doctors who order fewer or less expensive tests.

According to the study published in JAMA Internal Medicine, expensive medical care does not translate to better health outcome.

Researchers examined spending records of 72,042 physicians at more than 3,000 acute care hospitals. The patients were fee-for-service Medicare beneficiaries 65 years and older treated between January 2011 and the end of 2014.

The investigators calculated spending in the first two years, and tracked outcomes in the last two. They concentrated on the types of spending controlled by doctor choice — tests, procedures, imaging studies and so on.

After adjusting for the varying characteristics of the hospitals, they found that spending among physicians varied by as much as 10.5 percent.

But there was no association over all between higher physician spending and 30-day mortality, or between spending and readmissions. In other words, more spending did not yield better results.

Lead author, Dr. Yusuke Tsugawa, a researcher at the Harvard T.H. Chan School of Public Health said, “Even when you go to the same hospital, you’re going to get a different bill — as much as 40 percent higher — depending on who treats you, and you’re not getting better care from a doctor who submits a higher bill.”

Senior author Anupam B. Jena, who is also a physician at Massachusetts General Hospital, said “It could be that some doctors don’t fully consider the costs associated with the tests and procedures they order, and so policymakers or insurers could create incentives to curb some of the more wasteful spending.”

“On the other hand, some doctors might just be less efficient than others and may need additional resources to arrive at a proper diagnosis or an effective treatment.

“Whatever the causes of the variation, the study underscores the impact of decisions made by individual doctors on health care spending,” Jena added.

Have you had a similar experience in a hospital before? Share your thoughts with us.


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