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Editorials |

Does More Health Care Spending Produce Better Health and Happier Doctors?

Robert A. Berenson, MD
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Fom Urban Institute, Washington, DC 20037.

Potential Financial Conflicts of Interest: Grants received: (Robert Wood Johnson Foundation).

Requests for Single Reprints: Robert A. Berenson, MD, Urban Institute, 2100 M Street NW, Washington, DC 20037; e-mail, RBerenso@ui.urban.org.

Ann Intern Med. 2006;144(9):694-696. doi:10.7326/0003-4819-144-9-200605020-00015
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Over 3 decades, researchers at Dartmouth Medical School's Center for Evaluative Clinical Sciences, headed by Dr. John Wennberg, have produced a remarkable series of studies challenging the assumption that the more we spend on health care, the better health we get. They found more than a 2-fold difference in Medicare per capita spending across U.S. regions, particularly for patients with end-stage, chronic illnesses. Furthermore, per capita spending in a region is strongly correlated with the region's supply of physicians and hospital beds (1). More recently, they found no evidence that greater spending, more resource inputs, and more frequent use of hospitals and physician services are associated with improvements in survival, functional status, or patient satisfaction with care (2) or better performance on technical measures of care processes (3).



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