Laura Hershey: Writer, Poet, Activist, Consultant Rotating Header Image

Does Dartmouth Study Distort Health Spending Data?

In the ongoing health care debate, it seems that we hear more frequently about patients costing too much money, rather than about the vast amounts being hoarded by the profit-hungry corporate insurance system and/or wasted by senseless decisions in both the private and public sector.

A current article in the New York Times describes the findings of a study conducted by Dartmouth health policy researchers, which criticizes hospitals that provide extensive treatments to people who are “dying.” But, as the article points out, the Dartmouth study only included figures relating to patients who did die. It leaves out very sick patients who received treatments and lived, or even got better.

For example, the article describes the case of 71-year-old Salah Putrus, who had a long history of heart failure and was hospitalized in order to be evaluated for a heart transplant. Despite his age, doctors at UCLA Medical Center pursued proactive diagnoses and treatments. “They changed his medicines to reduce the amount of water he was retaining,” the article reports. “They even removed some teeth that could be a potential source of infection. His condition improved so much that more than six months later, Mr. Putrus has remained out of the hospital and is no longer considered in active need of a transplant.”

This is an important corrective to the typical arguments against spending money to treat elderly and sick people. “Because Dartmouth’s analysis focuses solely on patients who have died, a case like Mr. Putrus’s would not show up in its data,” the article explains. “That is why critics say Dartmouth’s approach takes an overly pessimistic view of medicine: if you consider only the patients who die, there is really no way to know whether it makes sense to spend more on one case than another.”

Another study, in fact, demonstrates that in treating people with heart failure, spending more does result in higher rates of recovery. The hospital with the highest rates of spending on heart failure treatment demonstrated one-third fewer deaths six months after an initial hospital stay. This is not futile spending, but rather spending that does what medicine is supposed to do: save lives and improve people’s health. To argue against such spending is ethically indefensible, yet such arguments seem to be gaining ground.

Policymakers need to consider different sources of data when considering expenditure decisions. In the words of one epidemiologist quoted in the Times article, “If you only look at the failures, you miss the benefit.”

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