The study, published in The Journal of Trauma and Acute Care Surgery, also indicates that the increasing health care costs could be controlled if analysts pay more attention on how patients are managed by their caregivers in lower-cost regions of the nation.
“At least in the case of trauma care, spending more doesn’t always mean saving more lives. If doctors in the Northeast do things more economically with good results, why can’t doctors out West do the same thing? This study provides a potential road map for cutting unnecessary costs without hurting outcomes.
However, the exact reason as to why costs vary by region remains unknown. According to Haider, it could be that in one part of the country, it may be routine to conduct an expensive type of medical test before treatment, while in other regions, that test may not be conducted.
In the United States, health care costs account for around 16% of the Gross Domestic Product (GDP), with trauma-related disorders being among the top 5 most expensive conditions.
For the study, the researchers examined three years of data from the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS). The team analyzed data on 62,678 adult patients with a primary injury in 1 of 5 domains:
- collapsed lung and bleeding in the chest
- blunt injury to the spleen
- mild traumatic brain injury
- shinbone (tibia) fracture
- liver injury
According to the researchers, the average per-person cost in the Northeast for trauma care for all 5 injury types combined was $14,022. In the West the cost was 33% higher, 22% higher in the Midwest, and 18% higher in the South.
Liver injury was the most expensive of the five injury types. In the Northeast, the average cost of care for liver injury was $16,213 vs. 35% more in the West, 22% more in the Midwest and 18% more in the South.
The team found that the West had the highest costs for each of the injury types, even after taking into account known differences in the widely used consumer price index, while the Northeast had the lowest costs.
According to Haider, when researchers are seeking ways to reduce costs, they should closely examine the outcomes beyond survival alone in order to ensure the more expensive care isn’t better in some way.
“For example, it may be possible, that higher-cost regions have patients with less pain and fewer disabilities after recovery.
If surgeons are fixing tibia fractures in the West in a way that’s more expensive but makes patients more comfortable, that would not be a trivial finding. We really need to drill down and figure out what parts of care improves outcomes and what parts drive up costs without improving any outcomes or aspects of care important to patients.”
The research was supported by the National Institutes of Health’s National Institute of General Medical Sciences, the American College of Surgeons and the Hopkins Center for Health Disparities Solutions.
Written by Grace Rattue
Johns Hopkins University School of Medicine