by Chad Schaeffer, MS, FACHE
A recent study published in the Journal of the National Comprehensive Cancer Network finds that spending more on healthcare does not always correlate to better outcomes. The authors of the article, “Wealth, Health Expenditure, and Cancer: A National Perspective,” studied different areas of the U.S. and looked at the wealth, spending, and cancer outcomes for breast cancer, colorectal cancer, and all cancers.1
The researchers, led by Dr. Jad Chahoud, point out that in 2013 the U.S. spent $2.9 trillion on healthcare—more than any other country—yet ranked 27 in life expectancy compared with the 34 countries that comprise the Organization for Economic Co-operation and Development (OECD). Their conclusion is that the U.S. healthcare system is flawed by an unequal resource allocation and socioeconomic disparities. This has long been the case when the U.S. is compared to many European countries, which have universal healthcare or a single-payer system and access to healthcare is often more consistently available to all citizens.
However, things get very interesting when the researchers compare different regions within the U.S. and find differences in cancer outcomes. When looking at colorectal cancer and all cancers, the common theme is that wealthier states, such as New York, Illinois, and California, tended to have better outcomes compared to the least wealthy states, such as Mississippi, West Virginia, and Alabama. The wealthier states spent more per capita, but not necessarily for healthcare. For instance, West Virginia spent more on healthcare per capita ($7,667.14) than Illinois ($6,756.36), but the outcomes for colorectal and all cancers are better in Illinois.
|Mortality/Incidence Ratio (colorectal cancer)||Mortality/Incidence Ratio
Yet for breast cancer, the researchers discovered that paying more did correlate with better outcomes. They surmise that this could be the result of effective breast cancer screenings and an overall high level of breast cancer awareness.
As I read the article and the findings from the study, two or three points come to mind. The first point is that since the extra spending on healthcare was effective for breast cancer, and—if the authors are correct that screening was a major factor—this could be good news for colorectal cancer if we can continue to improve screening rates. The second point is that with the new emphasis from Medicare and other payers on paying for quality, perhaps there will be an improved value in our healthcare system, leading to better outcomes. The last thought is that with the Affordable Care Act in place for several years and more Americans now having health insurance, and with a greater emphasis on screenings, would this potentially change the outcomes? It is too early to say for certain, but if screenings rates improve, this will likely make a difference in overall outcomes. We will have to wait and see.
Chahoud J, Rieber AG, Semaan A. Wealth, health expenditure, and cancer: A national perspective. J Natl Compr Cancer Netw. 2016;14:972-978.
ACCCBuzz contributing blogger Chad Schaeffer, MS, FACHE, is Executive Director of the Edwards Comprehensive Cancer Center at Cabell Huntington Hospital. He serves on the ACCC Editorial Committee.