Thursday, April 23, 2009

Is more always better?

As in so many areas of life, there is no direct causative correlation between the amount of money spent and quality of services, progress, or positive outcomes for the individual. There are times when the right care is more expensive and there are times when the right care, the best care or intervention for the individual is less expensive. Simply throwing money at a problem is never a good idea. Sometimes as with some of the research cited below, it can actually produce worse outcomes. For example in the case of Medicare expenditures:
What's Enough, What's Too Much?
“Most important, the second of the two articles by Fisher and colleagues (2) demonstrates that patients in high-spending regions had no better survival (if anything, slightly worse) than those in lower-spending regions. Separate analyses of a sample of all Medicare beneficiaries further showed no gains in overall patient mortality, functional status, or patient satisfaction. “
http://www.annals.org/cgi/content/full/138/4/348
and
Relationship Between Regional Per Capita Medicare Expenditures and Patient Perceptions of Quality of Care
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2438036

Using our best Critical Thinking skills we need to learn from the best research and provide what works, which is not always and quite often not, what is most expensive.
Learning from Evidence in a Complex World
John D. Sterman, PhD
The author is with the MIT Sloan School of Management, Cambridge, Mass.
Correspondence: Requests for reprints should be sent to John Sterman, MIT Sloan School of Management, 30 Wadsworth Street, Room E53-351, Cambridge Massachusetts 02142 (e-mail: jsterman@mit.edu ).
"Policies to promote public health and welfare often fail or worsen the problems they are intended to solve. Evidence-based learning should prevent such policy resistance, but learning in complex systems is often weak and slow. Complexity hinders our ability to discover the delayed and distal impacts of interventions, generating unintended "side effects." Yet learning often fails even when strong evidence is available: common mental models lead to erroneous but self-confirming inferences, allowing harmful beliefs and behaviors to persist and undermining implementation of beneficial policies.
Here I show how systems thinking and simulation modeling can help expand the boundaries of our mental models, enhance our ability to generate and learn from evidence, and catalyze effective change in public health and beyond".
http://www.ajph.org/cgi/content/abstract/96/3/505
There is a great deal of research about what works best for children with developmental disabilities and mental health concerns. Quite often we spend a great deal of money on substandard treatment which do not provide the best outcomes for the child. In some situations the key is to spend a little more money for the right treatment, which frequently provides better results at a lower financial cost over the life of the child.
According to Leonard Bickman of Vanderbilt University, More is Not Always Better.
http://books.google.com/books?hl=en&lr=&id=gLWnmVbKdLwC&oi=fnd&pg=PA395&dq=cost+and+quality+of+mental+health+care&ots=0WR4Frur43&sig=gw2MTOx_5AYDOAFMPg5JLcBJNwM

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