Romley notes that in their analysis, they accounted for patients who have additional life-threatening conditions, such as AIDS or cancer, and adjusted for hospital, regional, and socio-demographic factors.
They estimated the number of lives that might have been saved if all patients in the sample were admitted to the highest-spending hospitals rather than to the lowest-spending, including 5,198 lives from heart attack, 11,089 from pneumonia, and 7,467 from stroke.
The analysis demonstrates that intensive spending by hospitals is associated with lower mortality, but it does not identify the specific interventions that account for that benefit, Romley says. Neither does it address value or cost effectiveness.
What it does address, he says, is whether more is really less. “Our evaluation suggests that more is more.”
The study has its limitations, the authors admit. High-spending hospitals might have lower thresholds for hospital admission, thereby admitting healthier patients. Another possibility is that high-spending hospitals may spend more because the patients they admit are sicker and require more care. This would lead the authors to underestimate the effect of hospital spending on mortality.
They warn their findings should “be interpreted with caution.” Higher hospital spending on these conditions may not produce better health outcomes outside of California (“although we know of no reason to doubt it,” they write); and the spending isn’t necessarily cost-effective, because alternative interventions might enhance population health at lower cost.
It’s a starting place. As they conclude, “Important questions about the efficacy and value of hospital care remain to be asked and answered.”