Over-treatment Minus Access Equals Poor Health Outcomes

At Health Action 2013, Elliott Fisher, Shannon Brownlee, and Jack Ebeler presented a vivid picture of American healthcare that combines over-treatment with limited access to care, yielding health outcomes that lag behind many other wealthy countries. It’s an odd combination that brings to mind how populations with poor food security can be vulnerable to both obesity and poor nutrition. Reflecting on this situation, the three concluded systematic approaches to delivering good care — health professionals working collaboratively — will be essential to delivering better health for Americans.

Fisher is well-known for his work on the Dartmouth Atlas of Healthcare, documenting tremendous variation in spending for health that bears no relationship to the quality of health delivered. Cost variations of two- to three-fold are explained more by the quantity of care delivered than by the quality of health results. In other words, he has found that more care does not equal better care. Real savings and health improvements will come, he said, from focusing on delivering high quality care to patients who are really sick, rather than simply providing more services across the board.

Brownlee, author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, cited statistics for unnecessary imaging tests, induced labor, and angioplasty to explain how it can be that 20 to 30% of every dollar spent on healthcare goes for unnecessary, ineffective, and even harmful treatments and procedures. She attributes over-treatment both to the greed of providers and the anxiety of poorly informed patients. She advocates for shared decision-making (between patients and providers) as a key to reducing over-treatment. Her perspective was driven both by data and personal experience. She recounted how the health of her father was ravaged by a severe reaction to a cholesterol-lowering medicine that he did not need.

Health Action 2013 is the annual advocacy conference sponsored Families USA, which this year focused on what it will take to fully implement the Affordable Care Act. In addition to system reform, a key theme was gearing up for the biggest push for health insurance enrollment in American history. A fascinating collaboration between health advocates, political activists, and the health insurance industry is coming together to make this happen in the coming year.

Click here to read more about the Enroll America campaign, click here to read more about the Dartmouth Atlas of Healthcare, and click here to read more about Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.

Medicare Cost Map image from “Health Care Spending, Quality, And Outcomes,” Published February 27, 2009 by The Dartmouth Institute for Health Policy & Clinical Practice