Heath Care Cost Discrepancies in the U.S. Tied to Physician Behavior

As new data emerges that health care spending has little relationship to health outcomes, a new study finds a correlation between the behavior of doctors and the total heath care dollars spent.

According to researchers at the VA Outcomes Group in White River Junction, Vermont and Dartmouth Medical School, physicians practicing in regions of the United States where health care spending is high are more likely to order tests, referrals, and treatments for their patients than those in low-spending regions.

Health care spending varies widely across the county and the study sought to determine whether spending discrepancies were due to patients being different (higher illness rates in certain parts of the country) or doctors being different.

The researchers surveyed 5490 primary care physicians, presenting them with clinical scenarios and asking how often they would order a specific test, referral, or treatment for each patient described.  They found that doctors who practiced in areas of high-spending consistently ordered more tests, referrals, and treatments than doctors who practiced in low-spending areas.

For example, when presented with a 35-year old man with prolonged back pain and foot weakness after heavy lifting, physicians in high-spending regions would order an MRI scan 82% of the time.  This compared to 69% of the time for physicians in low-spending regions.

The study’s primary author, Dr. Brenda Sirovich, Staff Physician at the White River Junction VA Medical Center and assistant professor of medicine at Dartmouth Medical School said “The strength of this study is that we were able to isolate the role of physicians in explaining the huge differences that we see in practice and spending across the regions.” 

The authors acknowledge that it is unlikely that physician behavior alone explains higher levels of spending in some regions of the country, and that differences in patient expectations may influence spending as well.  They do suggest that health care in the United States could cost up to 30% less if all regions could safely adopt the more conservative practice patterns of lower-cost regions.

The study appears in the October 24, 2005 issue of Archives of Internal Medicine.

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