[Congressional Record Volume 146, Number 132 (Thursday, October 19, 2000)]
[Extensions of Remarks]
[Page E1840]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


  RECOGNIZING THAT GREATER SPENDING DOES NOT GUARANTEE QUALITY HEALTH 
                                  CARE

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                      Wednesday, October 18, 2000

  Mr. STARK. Mr. Speaker, in these waning days of the 106th Congress, 
we are considering a bill that will give back nearly $30 billion to 
managed care organizations, hospitals, and health care providers. These 
groups argue that without spending increases, quality of health care 
will suffer. The assumption: more money means better care. Of course 
adequate funding is necessary to effectively run hospitals, health 
plans, and clinics--but is that all it takes to ensure quality?
  In fact, greater spending does not always guarantee better quality.
  I would like to call my colleagues' attention to a recent report 
published in the Journal of the American Medical Association (JAMA) 
entitled, ``Quality of Medical Care Delivered to Medicare 
Beneficiaries: A Profile at State and National Levels.'' This report, 
compiled by researchers at the Health Care Financing Administration, 
ranks states according to percentage of Medicare Free-for-Service 
beneficiaries receiving appropriate care. The researchers looked at a 
range of health problems, including strokes, heart failure, diabetes, 
pneumonia, heart attacks, and breast cancer. There is remarkable 
consensus in the medical community about what constitute appropriate 
care for these conditions. For example, health professionals agree that 
conducting mammograms at least every 2 years can save countless lives 
in the fight against breast cancer. They also agree that heart attack 
victims should be given aspirin within 24 hours of being admitted to a 
hospital.
  If the claims of the managed care, hospital, and provider groups are 
accurate, states receiving the most Medicare spending should implement 
more of these scientifically validated practices. So I compared state 
performance rankings with Medicare payment estimates (per beneficiary). 
The results do not support this view. In fact, the 10 best performing 
states received 17 percent less in Medicare payments per enrollee than 
the 10 worst performers. Clearly, more money does not automatically 
translate into better health care nor does less money mean poor health 
care.
  Furthermore, according to this JAMA report, all states could do a 
better job of implementing quality care. On average, only 69 percent of 
patients received appropriate care in the typical state. This figure 
dropped as low as 11 percent for certain practices, such as 
immunization screenings for pneumonia patients prior to discharge. A 
clear trend also emerged--less populous states and those in the 
Northeast performed better than more populous states and those in the 
Southeast.
  What accounts for these differences in performance? JAMA authors 
suggested that, ``system changes are more effective than either 
provider or patient education in improving provision of services.'' 
Perhaps this is why states that have instituted health care reform, 
such as Vermont and Oregon, demonstrated relatively high levels of 
performance at lower cost.
  Authors of the JAMA article further suggested that it is necessary to 
hold all stakeholders accountable, not just health care providers and 
health plans. This includes, ``purchasers, whether Medicare or 
Medicaid, . . . because they are making continual and important 
decisions that potentially balance quality against expenditures.''
  I call upon my colleagues to recognize that we too are accountable. 
Medical experts agree on best practices. So we must do more than just 
authorize spending, we must recognize what constitutes quality care and 
expect providers, hospitals, and health plans to deliver. Medicare 
beneficiaries across the United States deserve the best care available 
and this cannot be achieved through greater spending alone. We are 
fooling ourselves if we believe that more money will automatically 
translate to better care.

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