New York Times Examines Effect of Spending on Quality of Care

The New York Times on July 21 reported on a "growing body of research" by Dartmouth Medical School professor Dr. John Wennberg and others that questions "whether more is really better when it comes to health care." According to some of Wennberg's findings, published in the February issue of Health Affairs, certain areas of the country have a "glut" of medical providers and facilities, but Medicare patients in these regions do not show improvements in their health despite many more office visits and medical procedures. The research reveals that "the greater the supply [of doctors in an area], the greater the use," without evidence of healthier patients. Additional research published by Wennberg in May in the New England Journal of Medicine found a similar phenomenon among low-birthweight babies. The mortality rates for babies in areas with a greater supply of newborn intensive care resources were not significantly better than those for babies in areas with few resources. Dr. Donald Berwick, president of the Institute for Healthcare Improvement, said he considers Wennberg's research to be the "most important in this area" in the last 25 years. But the Times reports that Wennberg's findings are "controversial," especially coming at a time when other studies show that many Americans receive too little health care. Dr. Yank Coble, president of the American Medical Association, said that factors other than a region's supply of doctors, such as cultural preferences and the population's underlying health, should be considered when determining why certain areas use more medical services. Carmela Coyle, senior vice president for policy at the American Hospital Association, added, "The question is, what level of care is the right level of care? We should ask the questions, have the conversation, but not jump to the conclusion that more is better or less is better" (Kolata, New York Times, 7/21).