Expensive Care Doesn’t Buy Better Health, Harvard Study Finds

The study, published in JAMA Internal Medicine on Monday, is considered to be the first to examine the impact of individual physicians’ spending patterns on patient outcomes.

“If you spend more money on a car or a TV, you tend to get a nicer car or a better TV,” said senior author Anupam B. Jena, Associate Professor of Health Care Policy at Harvard Medical School. “Our findings show that’s not the case when it comes to medical care. Spending more doesn’t always mean you get better health.”

Research on variations in spending and outcomes among geographic regions and hospitals has produced mixed results, but most evidence suggests that greater spending does not reliably translate into better results.

“Before now, most of the research and efforts aimed at cutting spending and improving the value of care have been aimed at hospitals, health systems, and groups of doctors,” said lead author Yusuke Tsugawa, a research associate at the Harvard T.H. Chan School of Public Health. “The differences between hospitals and regions are important, but they’re only part of the puzzle. Our findings show how important it is to consider the differences between individual doctors in any effort to improve health care.”

As one of the research team, a physician at Massachusetts General Hospital Dr. Jena says, "It could be that some doctors don’t adequately reflect the costs associated with the tests and procedures they order and so policymakers or insurers could create incentives to curb some of the more wasteful spendings. On the other hand, some doctors might just be less efficient than others and may need additional resources to arrive at a proper diagnosis or an effective treatment. Whatever the causes of the variation, the study underscores the impact of decisions made by individual doctors on health care spending."