WASHINGTON - Medicare patients with more doctors to choose from do not necessarily get more or better care, researchers reported Thursday in an analysis demonstrating how complicated U.S. healthcare reform will be.
The Dartmouth Atlas analysis questions the Obama administration's hopes that health insurance reform legislation passed in March will do much to improve U.S. healthcare by helping 32 million more Americans get health insurance and providing more primary care.
They found huge variations in the quality of medical care across the country and even patients who should in theory have plenty of opportunity to see a doctor are not faring better health-wise.
The study supports frequent criticisms that more is not necessarily better when it comes to fixing U.S. healthcare. The United States already spends more per capita on healthcare than all other similarly developed countries yet has a sicker population.
"Our findings suggest that the nation's primary care deficit won't be solved by simply increasing access to primary care, either by boosting the number of primary care physicians in an area or by ensuring that most patients have better insurance coverage," said Dr. David Goodman, who helped lead the Dartmouth Atlas Project, based at Dartmouth Medical School in New Hampshire.
"Policy should also focus on improving the actual services primary care clinicians provide and making sure their efforts are coordinated with those of other providers, including specialists, nurses and hospitals."
It said the March legislation provided "a remarkable opportunity to widen access to health care while also improving quality and affordability.
"But simply increasing access to primary care may not be enough to realize improvements in the quality of care or in health outcomes."
It used Medicare, the federal health insurance plan for the elderly, for the analysis because Medicare patients are by definition insured and the program keeps good medical records.
One example, leg amputations: Diabetes patients lose sensation and small injuries that would heal quickly in a healthy person can fester in a diabetic and often feet or legs must be removed because of infection.
Good primary care should prevent such an extreme complication, but the analysis found large variations across the United States.
"Nationally, rates of amputation decreased about 26 percent between 2003 and 2007," reads the report, available online at http://www.dartmouthatlas.org.
"However, patients' risk of leg amputation varied dramatically depending upon who they were and where they lived."
For instance, only 0.3 in 1,000 people had a leg amputated between 2003 and 2007 in Provo, Utah, compared with 3.29 per 1,000 beneficiaries in McAllen, Texas -- a tenfold difference.
Previous Dartmouth studies have shown McAllen has plenty of physicians and suggest the doctors there perform more tests and diagnostics than in similar towns.
There can also be dramatic disparities.
"In El Paso, Texas, the disparity between blacks and whites was relatively low -- the rate of amputation among blacks (2.23 per 1,000) was less than twice the rate among whites (1.16 per 1,000)," they wrote.
"By contrast, the disparity in Charleston, South Carolina, was dramatic; blacks underwent amputation at a rate more than six times that of whites (5.55 versus 0.85 per 1,000)." (Reporting by Maggie Fox; editing by Andre Grenon)
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