Spending more on healthcare could harm patients, writes Stephen Black

One of the most deeply held beliefs among health professionals is that if they had more money to spend, they could do more good. This myth relies on the belief that more healthcare is better healthcare.

We have good evidence that this is not true. The best evidence comes from studies of public health spending on pensioners in the US, with analysis from the Dartmouth Atlas Project.

That spending varies greatly from region to region in the US and provides a chance to compare what we get for different rates of spending.

High-spend areas have more doctors, more hospital beds, more patient visits per doctor and so on. That has to be good - doesn't it?

But here is the killer fact. The Dartmouth Atlas people have good outcome data to show that all that extra money and extra healthcare in the high-spend areas gives, if anything, slightly worse outcomes than in the low-spend areas.

Some of the other findings presented by the Dartmouth team are similar to patterns seen in the UK. They suggest that many conditions show activity rates that correlate strongly with the resources available.

PA Consulting's preliminary work in England shows similar patterns. In fact, hospital beds per head of population is the single best predictor of intervention rates in England and far better than the underlying demographics that are supposed to drive demand.

Even in areas where intervention benefits patients, the intervention rates show little relationship with the supposed demographic drivers.

Providers should take note: medical discretion is fine, but it needs to be informed by evidence of benefit. Old habits die hard; more importantly, they may kill patients. -

Stephen Black is a consultant at PA Consulting. The next Myth-buster will be published on 23 August.