That's the conclusion of a report in the Annals of Internal Medicine, which calls into question some prevailing assumptions about value and quality care, and suggests that Medicare spending is not associated with better healthcare outcomes, or better process measures.
The distinction, the report implies, is that within the hospital, higher spending is equated with lower mortality, but that spending in outpatient settings may not be so cost-effective or useful.
The study looked at six diagnoses at admission: acute myocardial infarction, congestive heart failure, acute stoke gastrointestinal hemorrhage, hip fracture and pneumonia, at 208 California hospitals for 1999 to 2003 and from 2004 to 2008.
"Across theses conditions, controlling as best we can for patient health status, hospital characteristics like teaching affiliation, and regional factors, ...we found that hospitals that spend the most tend to have lower inpatient mortality," says John Romley, of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California.
Romley says that it's possible this could be just a California phenomenon. "But my own feeling is that this is probably hospital care versus other kinds of care. It could be that certain kinds of care in the hospital are more efficacious than certain kinds of care outside the hospital.