This one’s from last week, but well worth a quick look. A study in the Archives of Internal Medicine compared heart-failure mortality in the U.S. and Canada
Two findings emerged from a recent Archives of Internal Medicine report on heart-failure mortality rates. One affirms the notion that the U.S. is a leader in acute care, but the other finding offers evidence that there’s room for improvement in the management of chronic conditions.The report, which was released Nov. 28, compared 30-day and one-year mortality rates of American and Canadian heart-failure patients measured between 1998 and 2001. The findings: after risk standardization, the 28,521 U.S. Medicare beneficiaries studied had a lower 30-day mortality rate than the 8,180 similarly aged patients at hospitals in Ontario, Canada (8.9% vs. 10.7%), but one-year adjusted mortality rates were essentially the same (32.2% in the U.S. vs. 32.3% in Canada).
So in other words we spend a lot more here and there some short-term benefits, but soon enough the differences disappear (but of course the money is still gone!). I was struck by this particularly because Vic Fuchs did a study back in the 1980s at Stanford hospital comparing the outcomes of patients admitted to the same hospital by the faculty versus community doctors. Compared to the community doctors the faculty doctors supplied more services and spend more money on patients with similar acuity (i.e. similarly sick patients). And in the short term their patients had better results, but after several months outcomes were the same. When Fuchs talked to them with the results, both sets of physicians thought that their type of care (i.e. more intensive versus less intensive) was better for the patients.
The health economists, though, amongst us tend to believe that there’s precious little point paying a lot more money to keep very sick people alive slightly longer, when within a year they’re going to be as dead as the rest of them. And that appears to be the way it works in Canada too. Anyone really surprised? Of course with the Dartmouth data we also know that the same variation is exactly the case between different parts of the US.