An insurer in Utah is encouraging consumers to use less medical care, but a study of California hospitals suggests that sometimes spending more really does improve patient outcomes.

"As the battle over health care reform rages in Congress, Regence BlueCross BlueShield is using a slick Internet site, social media and billboards to say that consumers bear much of the blame for high premiums," The Salt Lake Tribune reports. "The campaign was kicked off by what the not-for-profit insurer believes is an unsustainable rise in health care costs, which lead to expensive insurance premiums that have been rising at double-digit rates for most of this decade." Regence spokeswoman Georganne Benjamin "said the campaign is meant to be educational, not political. But she acknowledges that it's part of a wider corporate effort to drive the discussion of health reform" (Beebe, 10/14).

But a new study by six California medical centers, published in the academic journal Circulation: Cardiovascular Quality and Outcomes, "underscores how difficult it can be to predict when additional treatments - and, thus, spending - will benefit a particular patient," The New York Times reports. Data from the Dartmouth Atlas "has tracked wide variations in spending among those same six hospitals to care for patients with chronic conditions, including heart failure, during the last six months of life. According to the Dartmouth thesis, higher spending does not translate to better outcomes for patients. But the California researchers drew a different conclusion. 'We see better survival rates at the hospitals that spend more,' said Dr. Michael K. Ong, the lead investigator for the study, who is a doctor at the UCLA medical center."

"In some ways, the findings are a result of looking at the problem differently. Dartmouth researchers looked at hospitalized patients who had died, and then worked backward to trace the variations in spending on their care before their deaths. The California study examined all heart failure patients who had been hospitalized to see how they fared. The hospital with the highest cost for such patients had one-third fewer deaths than the one that spent the least" (Abelson, 10/14).

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