US Needs to Rethink Spending for Chronic Illnesses, Dartmouth Study Says

The report should end the more-is-better myth in health care, said Donald M. Berwick, MD, President and CEO of the Institute for Healthcare Improvement. It also points to needed fundamental changes in the way the millions of chronically ill Americans are cared for. Whatever investment is made in their end-of-life care should be of the highest quality, the most useful, and most cost-effective—for instance, a better home health-care system.

Dr. LaRosa said that the longer people live, the more medical resources they will consume. Thus preventive medicine doesn’t save money over the long run. “Nothing we do, no social policy anyone comes up with, will decrease health care costs over the next 20 years.”

The payment system needs to be changed as well, the Dartmouth researchers believe. The report notes that when payment is based solely on utilization, hospitals that reduce the number or length of stays lose money. The authors call for a reimbursement system that rewards rather than penalizes provider organizations that successfully reduce excessive use of services and that institute broader strategies for managing patients with chronic illness.

Extensive research has documented that greater use is associated with worse outcomes, poorer quality, and lower satisfaction with care. To this end, the report said, academic medical institutions and federal agencies such as the National Institutes of Health need to define efficient clinical practices: whom to hospitalize, when to schedule a physician visit, and when to refer a patent to a medical specialist, home health agency, or hospice.

Dr. Munzer summed it up: “To bring about a change in physicians’ attitudes, we must reassess their motivation for entering the profession. We need physicians who not only have a head but also a heart.”

©2006 The Triological Society