Association Between Health Care Cost, Quality Inconsistent

Review of 61 studies shows inconsistent evidence for the direction of the association

THURSDAY, Jan. 3 (HealthDay News) -- The direction of the association between health care cost and quality is unclear, with inconsistent evidence indicating positive, negative, mixed, and indeterminate associations, according to a review published in the Jan. 1 issue of the Annals of Internal Medicine.

Peter S. Hussey, Ph.D., from RAND Health in Arlington, Va., and colleagues reviewed the literature and assessed data from 61 studies to examine the association between health care quality and cost.

The researchers found that 21 of the studies (34 percent) reported a positive or mixed-positive association, indicating that higher cost was linked to higher quality; 18 (30 percent) reported a negative or mixed-negative association; and 22 studies (36 percent) reported an imprecise or indeterminate correlation, a mixed association, or no difference. In many studies, the correlations were of low to moderate clinical significance. Seven of the nine studies that utilized instrumental variables analysis to address confounding by unobserved patient health status reported a positive association.

"This review suggests that the association between health care cost and quality is still poorly understood," the authors write. "Given the immediate policy importance of this research question, additional studies are needed that more carefully disaggregate the association between health care cost and quality while addressing confounding by patient health status."

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