Health Care Spending , Quality , and Outcomes More Isn ’ t Always Better

San Francisco Chicago New York Washington-Baltimore Detroit The U.S. health care system is broken. Overall life expectancy has improved, but the burden of chronic illness is increasing, and racial and socioeconomic disparities in mortality are widening.1,2 Almost 50 million Americans lack health insurance, and coverage for many others is inadequate.3 The safety and reliability of care in hospitals, surgical centers, nursing homes and physician offices is far from assured. And health care costs—already the highest in the world—are growing at a rate that poses a serious threat to patients, employers and the nation.

[1]  Peter R. Orszag,et al.  The challenge of rising health care costs--a view from the Congressional Budget Office. , 2007, The New England journal of medicine.

[2]  A. Jemal,et al.  Widening of Socioeconomic Inequalities in U.S. Death Rates, 1993–2001 , 2008, PloS one.

[3]  Elliott Fisher,et al.  Regional Variations in Health Care Intensity and Physician Perceptions of Quality of Care , 2006, Annals of Internal Medicine.

[4]  J. Skinner,et al.  Is technological change in medicine always worth it? The case of acute myocardial infarction. , 2006, Health affairs.

[5]  E. Fisher,et al.  Creating accountable care organizations: the extended hospital medical staff. , 2006, Health affairs.

[6]  S. Harper,et al.  Trends in the black-white life expectancy gap in the United States, 1983-2003. , 2007, JAMA.

[7]  E. Fisher,et al.  Malpractice liability costs and the practice of medicine in the Medicare program. , 2007, Health affairs.

[8]  Elliott S Fisher,et al.  Variations in the longitudinal efficiency of academic medical centers. , 2004, Health affairs.

[9]  Elliott S Fisher,et al.  Discretionary decision making by primary care physicians and the cost of U.S. Health care. , 2008, Health affairs.

[10]  J. Skinner,et al.  Are Regional Variations in End-of-Life Care Intensity Explained by Patient Preferences?: A Study of the US Medicare Population , 2007, Medical care.

[11]  J. Skinner,et al.  Relationship between regional per capita Medicare expenditures and patient perceptions of quality of care. , 2008, JAMA.

[12]  David N Gans,et al.  A house is not a home: keeping patients at the center of practice redesign. , 2008, Health affairs.

[13]  David Wennberg,et al.  The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care , 2003, Annals of Internal Medicine.

[14]  Elliott S Fisher,et al.  Physician workforce crisis? Wrong diagnosis, wrong prescription. , 2008, The New England journal of medicine.

[15]  Amitabh Chandra,et al.  Medicare spending, the physician workforce, and beneficiaries' quality of care. , 2004, Health affairs.

[16]  E. Fisher,et al.  Avoiding the unintended consequences of growth in medical care: how might more be worse? , 1999, JAMA.

[17]  J. Skinner,et al.  Inpatient care intensity and patients' ratings of their hospital experiences. , 2009, Health affairs.

[18]  R. Reischauer,et al.  Collective accountability for medical care--toward bundled Medicare payments. , 2008, The New England journal of medicine.

[19]  C. Schoen,et al.  How many are underinsured? Trends among U.S. adults, 2003 and 2007. , 2008, Health affairs.

[20]  David Wennberg,et al.  The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care , 2003, Annals of Internal Medicine.