Backwoods Health Care Outranks Urban Hospital: A Dartmouth Atlas Case Study

After discussing the Dartmouth Atlas in a Justmeans health editorial post last week, two weekend hospital visits gave me the chance to examine the Atlas' research findings personally. During these visits I saw that - as the Atlas researchers assert - health care delivered at expensive, well-equipped hospitals does not necessarily exceed care provided in cheaper hospitals with fewer resources. In fact, the treatment at the expensive hospital was worse.

I started suffering from a fever while vacationing with my girlfriend on Catalina Island, 20 miles and a 1.5 hour ferry ride from our home in Los Angeles. I went to the hospital and was diagnosed with cellulitis - a skin infection - in my elbow. Treatment required IV antibiotics in the hospital followed by oral outpatient antibiotics. The fever peaked again after we returned to the mainland the next day. This time I visited another hospital in West Los Angeles. Physicians there provided nearly identical treatment including two doses of IV antibiotics and prescriptions for antibiotics to take at home.

The medications were the same at the two hospital facilities but the similarities ended there. At the Catalina Island hospital I received care from one physician, a nurse, and an X-ray technician during a 3-hour stay. While staying overnight at the urban LA hospital, I saw three ER doctors, two physician assistants, an X-ray technician, and more than 6 nurses (I lost track while being shuttled between rooms at 3AM). The equipment and amenities in the hospitals also differed. For example, TVs in every room provided distractions during the lengthy gaps between physician visits at the urban hospital while the island hospital didn't have TVs.

Although I'm insured and my expenses will be minimal, these differences in hospital service - length of stay, staffing, and gadgetry - meant my health care at the second hospital cost more than at the island care center. They also made my visit at the urban hospital less pleasant. Long wait times, repeated explanations to medical staff, and admission to the hospital caused lost sleep and irritation, the perk of in-room TV entertainment quickly lost appeal when the patient in the next room kept infomercials at high volume, and the urine soaked cot I received in the ER added insult to injury. Since patient satisfaction is a key measure of health care quality my unpleasant hospital stay means that (for at least one patient) the backwoods island hospital outranks the fancy, urban hospital.

This assertion, that higher spending is not associated with increased quality in American hospitals is not unique to male cellulitis patients in Los Angeles. According to the Dartmouth Atlas, many patients have similar impressions. Dartmouth research shows that for Medicare patients near death, medical spending at expensive health care centers like the one I visited does not cause outcomes to improve. While the Atlas authors have recently found themselves under scrutiny for verbose statements about this correlation between health care spending and quality, their findings are well-supported. Although I hope to avoid future personal hospital examinations I'm glad that my visits lent further backing to my mentors' research.

Photo credit: Ano Lobb