Is Your Insurance Company Spending Too Much Money on Your Medical Care?

We all know that medical care is expensive. Newspapers, television commentators, analysts and insurance spokespersons constantly remind us of this, as well as every employer and politician.

Some recent articles have extended the discussion about whether America is spending too much on treatments that are not producing the right health benefits. An article by Dr. F. Fowler, Jr., from the Foundation for Informed Medical Decision Making at the University of Massachusetts and his colleagues (Journal of the American Medical Association, Volume 299, Page 2406, 2008) along with commentary by Dr. G. Anderson and Dr. K. Chalkidou from Johns Hopkins School of Public Health (Journal of the American Medical Association, Volume 299, Page 2444, 2008) have asked how much the government spends on medical care and the patient’s perception about the quality of their medical care.

In the study, Dr. Fowler and his co-authors asked 4,000 Medicare patients, 65% of whom responded, about the quality of their care and the utilization of care, and compared their responses with the amount that Medicare actually spent on their medical services. They compared the lowest regions which spent $5,200 per patient per year with the highest regions which spent $8,500 per year.

The results showed some expected and some unexpected findings. The patients in the lowest spending area had fewer visits with the physicians (3.4 per year) compared to the highest area (3.9 per year), and the patients in the highest spending region saw more physicians (2.8 per year) compared to the lowest spending region (2.4 per year). The greatest differences were in the area of cardiac care (of course older patients more commonly die from heart disease than from any other cause). Only 23% of patients in the lowest spending region saw a cardiologist and the patients had fewer tests (40.1%), compared to the highest spending region, where 37% of patients saw a cardiologist and 64% had received a cardiac test. Despite this, and despite a higher utilization of specialists (3% in the lowest area versus 8% in the highest), the rating of their care as excellent was 63% in the lowest spending area compared to only 55% in the highest spending area! And in addition, patients in the lowest spending area saw their doctor less frequently!