Featured Research

from universities, journals, and other organizations

Lower-cost hospital care is not always lower in quality

Date:
February 24, 2010
Source:
JAMA and Archives Journals
Summary:
The costs that hospitals incur in treating patients vary widely and do not appear to be strongly associated either with the quality of care patients receive or their risk of dying within 30 days, according to a new report.

The costs that hospitals incur in treating patients vary widely and do not appear to be strongly associated either with the quality of care patients receive or their risk of dying within 30 days, according to a report in the February 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

"Hospitals face increasing pressure to lower cost of care while improving quality of care," the authors write as background information in the article. However, critics have expressed concerns about the trade-off between the two goals. "In particular, might hospitals with lower cost of care and lower expenditures devote less effort to improving quality of care? Might the pursuit of lower cost of care drive hospitals to be 'penny wise and pound foolish,' discharging patients sooner, only to increase re-admission rates and incur greater inpatient use over time?"

Lena M. Chen, M.D., M.S., of the University of Michigan, Ann Arbor, and colleagues conducted a national study of hospitals that discharged Medicare patients who were hospitalized for congestive heart failure or pneumonia in 2006. For each condition, the researchers used data from national databases to examine the association between hospital cost of care and several variables: 30-day death rates, readmission rates, six-month inpatient cost of care and a quality score based on several performance indicators for each condition.

Costs of care for each condition varied widely. Care for a typical patient with congestive heart failure averaged $7,114 and could range from $1,522 to $18,927, depending on which of the 3,146 hospitals discharged the patient. Cost of care for a typical patient with pneumonia averaged $7,040 and varied from $1,897 to $15,829 per hospitalization among 3,152 facilities.

"Compared with hospitals in the lowest-cost quartile [one-fourth] for congestive heart failure care, hospitals in the highest-cost quartile had higher quality-of-care scores (89.9 percent vs. 85.5 percent) and lower mortality [death] for congestive heart failure (9.8 percent vs. 10.8 percent)," the authors write. "For pneumonia, the converse was true. Compared with low-cost hospitals, high-cost hospitals had lower quality-of-care scores (85.7 percent vs. 86.6 percent) and higher mortality for pneumonia (11.7 percent vs. 10.9 percent)."

Hospitals with lower costs had similar or slightly higher 30-day readmission rates (24.7 percent for congestive heart failure and 17.9 percent for pneumonia) when compared with higher-cost hospitals (22 percent for congestive heart failure and 17.3 percent for pneumonia). However, patients initially seen in lower-cost hospitals still incurred lower overall costs of care over six months compared with patients initially seen in higher-cost hospitals ($12,715 vs. $18,411 for congestive heart failure and $10,143 vs. $15,138 for pneumonia).

"Our findings did not support the hypothesis that hospitals seeking to lower cost of care by discharging patients earlier ultimately use more hospital resources over time," the authors write. "Although low-cost hospitals had about 20 percent shorter length of stay, their patients had comparable or marginally higher readmission rates and substantially lower six-month total inpatient cost of care. Therefore, our findings suggest that initial lower hospital cost of care may not have a deleterious effect on long-term inpatient use."

Editorial: More Research Needed to Reduce Costs While Maintaining Quality

"Controlling hospital costs is central to lowering overall health care costs," writes Mitchell H. Katz, M.D., of the San Francisco Department of Public Health, California, in an accompanying editorial. "But can hospital costs be reduced without harming the quality of services? The article by Chen et al in this issue of the Archives makes an important contribution to this debate. The authors found no consistent relationship between the cost of hospital care and the quality of that care for two common diagnoses: congestive heart failure and pneumonia."

"Fortunately, there are interventions that show promise in decreasing hospital costs without harming quality. For example, decreasing length of stay for certain conditions can safely decrease costs. Indeed, Chen and colleagues found that lengths of stay were significantly longer at high-cost hospitals for both congestive heart failure and pneumonia."

"To increase progress on lowering hospital costs without harming quality, we need more comparative effectiveness studies -- specifically, studies that show that two interventions of different costs are of equal value," Dr. Katz concludes. "This research is critical to increasing quality of care at the same time as we decrease cost, so that we can afford to expand health care coverage for the uninsured."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal References:

  1. Lena M. Chen; Ashish K. Jha; Stuart Guterman; Abigail B. Ridgway; E. John Orav; Arnold M. Epstein. Hospital Cost of Care, Quality of Care, and Readmission Rates: Penny Wise and Pound Foolish? Arch Intern Med, 2010; 170 (4): 340-346 [link]
  2. Mitchell H. Katz. Decreasing Hospital Costs While Maintaining Quality: Can It Be Done? Arch Intern Med, 2010; 170 (4): 317-318 [link]

Cite This Page:

JAMA and Archives Journals. "Lower-cost hospital care is not always lower in quality." ScienceDaily. ScienceDaily, 24 February 2010. <www.sciencedaily.com/releases/2010/02/100222161852.htm>.
JAMA and Archives Journals. (2010, February 24). Lower-cost hospital care is not always lower in quality. ScienceDaily. Retrieved September 18, 2014 from www.sciencedaily.com/releases/2010/02/100222161852.htm
JAMA and Archives Journals. "Lower-cost hospital care is not always lower in quality." ScienceDaily. www.sciencedaily.com/releases/2010/02/100222161852.htm (accessed September 18, 2014).

Share This



More Health & Medicine News

Thursday, September 18, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Artificial Sweetener Could Promote Diabetes

Artificial Sweetener Could Promote Diabetes

Newsy (Sep. 17, 2014) Doctors once thought artificial sweeteners lacked the health risks of sugar, but a new study says they can impact blood sugar levels the same way. Video provided by Newsy
Powered by NewsLook.com
Ebola Vaccine Trial Gets Underway at Oxford University

Ebola Vaccine Trial Gets Underway at Oxford University

AFP (Sep. 17, 2014) A healthy British volunteer is to become the first person to receive a new vaccine for the Ebola virus after US President Barack Obama called for action against the epidemic and warned it was "spiralling out of control." Duration: 01:02 Video provided by AFP
Powered by NewsLook.com
Obesity Rates Steady Even As Americans' Waistlines Expand

Obesity Rates Steady Even As Americans' Waistlines Expand

Newsy (Sep. 17, 2014) Researchers are puzzled as to why obesity rates remain relatively stable as average waistlines continue to expand. Video provided by Newsy
Powered by NewsLook.com
President To Send 3,000 Military Personnel To Fight Ebola

President To Send 3,000 Military Personnel To Fight Ebola

Newsy (Sep. 16, 2014) President Obama is expected to send 3,000 troops to West Africa as part of the effort to contain Ebola's spread. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins