| 摘要: | Expenditures by the U.S. Medicare program have demonstrated a trend of being flat-of-the-curve medicine, where incremental spending above a certain point produces no incremental health benefit (Fuchs, 2004). Since 1996, acute myocardial infarction survival gains have stagnated, while Medicare costs have continued to increase (Skinner, Staiger, & Fisher, 2006). Medicare enrollees in higher spending regions of the United States received more care than those residing in lower spending regions, but these enrollees did not have greater improvements in survival and functional status or in satisfaction with care (Fisher et al., 2003 E.S. Fisher, D.E. Wennberg, T.A. Stukel, D.J. Gottlieb, F.L. Lucas and E.L. Pinder, The implications of regional variation in Medicare spending. Part 1: The content, quality, and accessibility of care, Annals of Internal Medicine 138 (2003), pp. 288–298. View Record in Scopus | Cited By in Scopus (355)Fisher et al., 2003). A recent study of California hospitals also reported that some hospitals spent up to four times more than others in that state to treat patients with similar conditions. However, these additional costs did not result in any gains in quality, patient satisfaction, or health outcomes (Benko, 2005).
In reality, whenever physicians and nurses treat their patients by following procedures based on their most current knowledge and best judgment, patients will not die from the consequences of poor care quality, such as medication or procedure errors. Advanced medical technology may, for example, assist physicians and nurses identifying problems, maintain patients' vital signs, extend patients' life, and allow more time for patients to recover. Any gains in quality are always built on top of comprehensively following professional practice standards, not on technology alone. |
