title: Is spending more always wasteful? The appropriateness of care and outcomes among colorectal cancer patients.
abstract: Increased area-level medical spending is not correlated with improved patient outcomes or quality, thereby supporting the case for spending reductions in high-spending regions. However, all additional spending need not be wasteful. Examining the care of patients with colorectal cancer, we show that high-spending regions are more likely than other regions to use recommended care but are also more likely to use discretionary and nonrecommended care, the latter of which has adverse outcomes for patients. Our results show that instead of cutting spending, policies designed to target services to patients most likely to benefit could increase the value of medical spending.
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA. landrum@hcp.med.harvard.edu
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Meara
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chandra
authors.forename: Edward
authors.initials: E
authors.lastname: Guadagnoli
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D018426:SEER Program; D017062:Small-Area Analysis; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology