Based on 1994 and 1995 data, the rates at which Medicare patients die in the hospital correlate closely with the number of hospital beds per thousand residents in their community. Researchers call this correlation the “Field of Dreams Effect,” after the line in the 1989 movie about a baseball field: “If you build it, they will come.”
While there is little evidence to show that patients are helped or harmed by the more intensive care they receive in Boston, Memphis, and other high-use areas of the country, the differences in use have a major impact on medical care costs. For example, the average hospital bill for each Medicare enrollee’s final six months of life was $16,571 in the New York City borough of Manhattan, as opposed to an average of only $6,793 in Portland, Oregon.12 In the Boston–New Haven comparative study, Boston’s per capita hospital expenditures were about double those of New Haven.13
Wennberg does not specifically argue that conflict of interest or pecuniary motives enter into decisions that determine use rates of medical services. However, many studies suggest that financial considerations may enter into some physicians’ medical decision making. For example, there is evidence that when physicians stand to profit from the performance of diagnostic tests, they are much more likely to order such tests. Until the practice was outlawed by Congress, physicians who owned an interest in clinical laboratories were more likely to refer patients for laboratory tests than similar physicians who referred patients to labs in which they had no financial interest.14 Similarly, physicians who own diagnostic imaging equipment are more likely to use it than comparable physicians who must refer patients elsewhere for such examinations. Physicians in Japan, who are legally permitted to sell prescription drugs directly to patients (unlike in the United States), appear to favor higher-profit drugs.15,16 A recent surge in complex spinal-fusion operations has been linked to the high rates Medicare will pay to surgeons and hospitals, although there is no evidence that the procedure is more effective at curing back pain than laminectomies or even less invasive approaches.17
1. Describe how “The Field of Dreams” relates to healthcare.
2. Metro Detroit Area has a number of hospitals. Do you think that they are experiencing the Field of Dreams there?
Answer a or b depending on if you said yes or no to #2
3. Depends on your answer for #2.
3a. If your answer was yes to #2, then why are there still disparities in health care in Detroit? Is there a reason why you think the Field of Dreams left this part of the region out?
3b. If your answer was no to #2 and knowing that our area has disparities in health care, what do you think could be done to close these gaps? (is there a way to attract more health care professionals to Detroit? Is
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