Reports from the field: More health care doesn’t mean better health care, report says

Regions of the United States where more health care is delivered don’t provide better care than regions with more conservative practice patterns, according to studies by researchers at Dartmouth Medical School and the Veteran Affairs Medical Center in White River Junction, VT.1

The studies examined how regional difference in the amount of care received by Medicare patients affected the quality of care and access to care as well as outcomes and patient satisfaction. Researchers examined data on patients hospitalized for hip fractures, colorectal cancer, and acute myocardial infarction.

When they examined regions with nearly identical health care needs, the researchers found that the overall quantity of services could vary by more than 60%. The increased utilization included more frequent physician visits, greater use of specialists, and more inpatient stays.

Patients in the regions with higher intensity of care didn’t have any better chances of survival, nor did they express greater levels of satisfaction, the researchers say.

Researchers found that performing more medical service didn’t improve any of the measures. In fact, on some measures, such as access to preventive care, high-intensity regions fared worse.

"People assume that more medical care means better medical care. What this study shows us is that a large fraction — perhaps a third — of medical care is devoted to services that do not necessarily improve health outcomes or the quality of care," says Elliott Fisher, MD, MPH, co-director of the outcomes group at the Veterans Affairs Medical Center and a professor of medicine at Dartmouth Medical School.

Most of the regional differences were due to the greater number of medical specialists and hospital beds in higher intensity of regions, Fisher says, adding "We should focus on rewarding health care systems for providing better care, not more or less care."


1. Fisher E, Wennberg D, Stukel T, et al. The implication of regional variations in Medicare spending. Ann Int Med 2003; 138:237-287.