Top-Spending Hospitals Save More Lives After Heart Attack

HealthLeaders Media Staff, February 7, 2011

When hospitalized for a major acute medical condition—including heart attack, stroke and pneumonia—patients were less likely to die in high-spending hospitals, according to a study in the Feb. 1 issue of the Annals of Internal Medicine.

The findings suggest that while regions spending more on healthcare generally produce no better care, specific types of medical spending save lives, explains John Romley, PhD, an author of the study and an economist with the Schaeffer Center for Health Policy and Economics at the University of Southern California.

Or, as he tells HealthLeaders Media, sometimes less is not more, it’s less. The “less as more” concept is grounded in research, he acknowledges. Other research has shown regions that spend more on medical care do not have better health outcomes than those that spend less.

What’s not known is how medical spending affects health at certain critical times. Does this pattern hold up in the hospital context?  For purposes of this research, it doesn’t

He and his colleague, Dana Goldman, PhD, Norman Topping Chair in Medicine and Public Policy at USC and director of the Schaeffer Center, looked at discharge records for more than 2.5 million patients admitted to 208 California hospitals from 1999 to 2008 with one of six major medical conditions: heart attack, congestive heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, or pneumonia.

They found that as hospital spending went up, the risk of dying in the hospital from the condition that caused hospitalization went down.

For example, from 2004 to 2008, patients admitted for heart attack to the top-spending hospitals were 19 percent less likely to die than patients admitted to the lowest-spending hospitals. From 1999 to 2003, patients admitted for heart attack were 9 percent less likely to die at the highest-spending hospitals than at the lowest-spending ones.

“Adjusted inpatient mortality was negatively associated with hospital spending for all six diagnoses, meaning those admitted to hospitals that spent the most were less likely to die in the hospital than were patients admitted to hospitals that spent the least,” Goldman said in a prepared statement.