More May Not Be Better, Medicare Study Says

Medicare patients being treated for serious, often life-shortening conditions in the highest-spending regions got about 60% more care but "we don't see any evidence they're living longer," said Dr. Elliott S. Fisher, lead researcher for the study, to be published in the Annals of Internal Medicine.

Nor did Medicare patients in the lower spending groups deteriorate faster. "There's no difference in the rate of decline," said Fisher, an internist, Dartmouth Medical School professor and co-director of the Outcome Group at the Veterans Affairs Medical Center in White River Junction, Vt.

By these and other measures, including access to care and patient satisfaction, the study determined that people receiving the most care did not fare better.

In a country with 40.3 million Medicare beneficiaries and rapidly rising health-care costs, the implications are substantial for the government insurance program serving elderly and disabled people, researchers said. According to the latest figures available, Medicare spending increased 7.8% in 2001 over the previous year.

With more restraint on the part of physicians, the study concluded, "savings of up to 30% of Medicare spending might be possible, and the Medicare Trust Fund would remain solvent into the indefinite future."

But the researchers, who looked at nearly 1 million patients in 306 cities and counties nationally, warned that those seeking to cut costs in the higher-spending regions should proceed with caution and await further research.

In an accompanying commentary, former Medicare administrator Gail Wilensky said the study offered "the best rationale to date

Wilensky noted, however, that figuring out how to set limits is difficult: "We need more thought about how to reward physicians who practice high-quality conservative medicine."

To set up the study, the researchers -- most of whom are from Dartmouth -- established Medicare spending patterns across the country, based on what was spent, on average, in the last six months of life.

They chose end-of-life spending to ensure the similarity in the various regions of the health status of the patients involved. The study also was adjusted for sex and race of patients and geographic variations in Medicare pricing.