MedicalResearch.com Interview with:
Yusuke Tsugawa, research associate
Department of Health Policy and Management
Harvard T H Chan School of Public
Division of General Internal Medicine and Primary Care
Brigham and Women’s Hospital, Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It is well known that health spending varies substantially across geographical regions, and yet regions that spend more on health care dot not achieve better health outcomes. These findings has led to many to conclude that at least 20% of U.S. health care spending could be reduced without compromising quality of care. However, while physicians play a critical role in health care decision making, little is known as to how much health care spending varies between physicians, and its implications for patient outcomes.
In this study, we found that the variation in spending across physicians is slightly larger than the variation across hospitals. More importantly, higher spending by physicians did not lead to lower patient mortality or readmission rates, within the same hospital.
MedicalResearch.com: What should readers take away from your report?
Response: Our findings suggest that policies that target individual physicians in addition to hospitals, may be more effective than those influencing hospitals, to reduce health care spending while improving the quality of care.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Further studies are warranted to understand why some physicians are spending health care dollars more than others, and to effectively reduce health care services that are not delivering values to patients.
MedicalResearch.com: Is there anything else you would like to add?
Response: Although our findings suggest that physician-focused health care reforms could improve the efficiency of health care spending – i.e., reduce physician-driven spending without harming patients health – that may not be true. In our study, we could not assess why some physicians spent more than their colleagues in the same hospital. If higher spending physicians do so to compensate for lower clinical skill or lower comfort in dealing with the uncertainty of clinical decision making, incentivizing these physicians to utilize fewer resources could actually worsen patient outcomes. In contrast, if higher spending physicians simply spend more because they do not directly face the costs of ordering an additional test or procedure, and would otherwise feel comfortable spending less, it’s possible that spending by these physicians could be reduced without adversely affecting patient outcomes.
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Tsugawa Y, Jha AK, Newhouse JP, Zaslavsky AM, Jena AB. Variation in Physician Spending and Association With Patient Outcomes. JAMA Intern Med. Published online March 13, 2017. doi:10.1001/jamainternmed.2017.0059
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