There is a lot of variation in levels of medical treatment and spend across the USA. That variation has been studied by, for example, The Dartmouth Atlas Project. They conclude that more isn't better:

In regions where there are relatively fewer medical resources, patients get less care; however, there is no evidence that these patients are worse off than their counterparts in high-resourced, high-spending regions. Patients do not experience improved survival or better quality of life if they live in regions with more care. In fact, the care they receive appears to be worse.

Is is true that more medical interventions and higher spend don't improve the outcomes for patients?

  • It would be better to have some time frame or location frame, since this claim is too broad. It could be counter-proved, for example, showing how life expectancy improved a lot since middle age, or how patients who have received medical care after suffering some heart condition have more life expectancy then those who had none. – woliveirajr Jan 26 '17 at 12:07
  • @woliveirajr There is an implicit timeframe (the latest few decades) and location frame (the claim is based on data for the USA, but I don't want to rule out other evidence elsewhere). – matt_black Jan 26 '17 at 12:34
  • Freakonomics recently had 3 bad medicine podcasts, i think one of the claims was similar. – user5341 Jan 26 '17 at 12:50
  • As an example - broader testing for things like PSA in older men has resulted in more surgeries to remove prostates. These surgeries are not without risk from immediate and/or long-term side effects - and PSA is not a direct test for cancer. – HorusKol Jan 26 '17 at 22:31
  • Are you asking if the association claim is accurate, or if it is causal (doing more medical procedures makes people sick). – De Novo Nov 7 at 18:13

In a 2014 study, three doctors from the Department of Surgery, University of Michigan, Ann Arbor determined that programs with more medical interventions in the form of hospital treatment intensity (or "aggressive treatment style") have differing outcomes from the others. The found that these programs are better at rescuing patients, but did have higher complication rates.

We observed a small, but statistically significant, increase in the rates of major complications for patients treated at high– compared with low–care intensity centers. In contrast, failure-to-rescue rates were lower at high–care intensity hospitals, potentially indicating differences in complication management compared with low–care intensity centers. Despite this, HCI explained a small proportion of the overall variation in failure-to-rescue rates across hospitals.

The also noted that this kind of program "is highly correlated with per-patient health care expenditures."

No, more medical interventions and higher spend don't automatically improve the outcomes for patients. At this point we have an enormous amount of medical literature claiming for the reduction of overdiagnosis and overtreatment. More and more interventions are approved with clinical trials that are far from mirroring the real-world, with strict inclusion criteria and surrogate endpoints. The BMJ’s Too Much Medicine initiative was launched for facing the threat to human health posed by overdiagnosis and unnecessary care.

The short answer is that more medical interventions and higher spend do not automatically improve the outcomes for patients. Instead of spending more, healthcare system should be spending smarter. Moreover, blindly trying to reduce spending (e.g. by decreasing Medicare funding) will likely make patients outcome worse.

Now the details:

  • The main study on Outcomes says "Efforts to reduce spending should proceed with caution, but policies to better manage further spending growth are warranted." So they are not advocating reduced spending.

  • Research is out of date. The report you cite is from 2007, and it is based on research papers from 2003, which used data for "Patients hospitalized between 1993 and 1995", and followed up for 5 years afterwards. That is 20 years ago, and healthcare has changed a lot since then. But many issues remain.

  • Study is based on three conditions, only one of which is major killer. There is no Diabetes, no lung conditions, no chronic heart conditions, the cancer is 3d most common.

  • The main study on outcomes mostly finds no change in outcome. The "worse outcome" is significant only in one of three conditions, on one of three measures. There is a second study that I do not have time to review.

  • Hospitals do overspend, but that is not an excuse to cut their funding. For one thing, they are required to provide free healthcare to everybody who walks into ER but cannot pay, and ER is the most expensive way to provide care. For another, there is medical liability issue: if hospital had capacity to provide extra care, but didn't, and patient died, hospital gets sued for millions of dollars and loses its reputation, doctors have to deal with all that. So doctors do order marginally-useful services as a precaution. So if you force them to reduce overall spending, they might cut it across the board, or base decision on medical liability rather than medical needs.

  • Spend is not a useful measure: same exact care will cost a lot more in NY city than in rural Alabama. Authors try to look at utilization rather than spending; I do not have time to review their complete methodology.

Some of the information contained in this post requires additional references. Please edit to add citations to reliable sources that support the assertions made here. Unsourced material may be disputed or deleted.

  • This answer is written as if the OP asks about a specific paper. That paper is not actually cited, either in the OP or in this answer. Also, the OP asks whether the general claim is true, not whether a specific paper validates the claim; a critique of the methods of one paper does not validate or invalidate the general claim. (There have been many, many, many papers in the last ~10 years addressing the general claim.) – ff524 Nov 7 at 21:41
  • Please provide some references to support your claims. – Oddthinking Nov 8 at 1:48

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