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Good News for U.S. Health Care: Medicare Deaths, Hospitalizations, and Costs Reduced

New study provides ‘jaw-dropping’ data

The U.S. health care system has scored a medical hat trick, reducing deaths, hospitalizations, and costs, according to an article in USA Today.

Mortality rates among Medicare patients fell 16% from 1999 to 2013. That’s equal to more than 300,000 fewer deaths a year in 2013 than in 1999, said cardiologist Dr. Harlan Krumholz, lead author of a new study in JAMA and a professor at the Yale School of Medicine.

“It’s a jaw-dropping finding,” Krumholz said. “We didn’t expect to see such a remarkable improvement over time.”

Krumholz and his colleagues based their study on records from more than 68 million patients in Medicare. They were able to find additional information about hospitalization rates and costs among Medicare’s traditional “fee-for-service” program, in which doctors and hospitals are paid for each procedure or visit. This information wasn’t available for people in the managed-care portion of Medicare, which had approximately 29% of patients in the overall Medicare program in 2013.

Among fee-for-service patients, hospitalization rates fell 24%, with more than 3 million fewer hospitalizations in 2013 than in 1999, Krumholz said. When patients were admitted to the hospitals, they were 45% less likely to die during their stay; 24% less likely to die within a month of admission; and 22% less likely to die within a year, the study found.

Costs for hospitalized patients also fell by 15% among fee-for-service patients.

Hospitals and their staffs get some of the credit for the improvement, Kumholz said. “There has been tremendous focus on making sure that our hospitals are safer and that treatments are more timely and effective,” he commented.

A 1999 report from the Institute of Medicine, which found that hospital errors killed up to 98,000 people each year, jump-started a movement to improve health care, according to P.J. Brennan, chief medical officer at the University of Pennsylvania Health System.

Public health improvements also likely played a part in cutting death rates, Krumholz said. While more Americans today are obese than in the 1990s, the air is generally cleaner and fewer people smoke. New drugs for common conditions such as cancer and heart disease also may have kept people alive longer.

“What’s gratifying is the cost savings don’t appear to have come at the expense of quality,” said Helen Burstin, chief scientific officer at the National Quality Forum, a nonpartisan group that aims to improve the quality of health care.

Burstin said she hopes the country will expand its efforts to improve health care quality by focusing on outpatient care, such as that given in nursing homes or by home health aides.

Krumholz said his results shouldn’t encourage complacency.

“The things we’re trying to do to make things better are working,” Krumholz said. “Rather than wave the victory flag, we want to see that trend continue. There’s no reason to take our foot off the pedal.”

Sources: USA Today; July 29, 2015; and JAMA; July 28, 2015.

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