The issue also contains articles finding that "consumer-driven" health plans at one large employer attracted disproportionate numbers of younger enrollees with relatively low health expenditures, http://content.healthaffairs.org/cgi/content/abstract/27/6/1671; that hospital ratings for consumers can often be confusing, http://content.healthaffairs.org/cgi/content/abstract/27/6/1680; that the capacity of hospitals to respond to mass-casualty events is insufficient and getting worse, http://content.healthaffairs.org/cgi/content/abstract/27/6/1688; and that the United States continues to spend more on health care than other industrialized nations but often does not achieve better results, http://content.healthaffairs.org/cgi/content/abstract/27/6/1718.

Expanded Use Of Imaging May Make Patients More Informed, But Benefits Are Unclear

Each new CT scanner on the market prompted another 2,224 additional CT procedures per year, adding $685,000 to the yearly Medicare bill, Baker and his colleagues found. Each new MRI unit led to 733 additional MRI procedures, adding $550,000 to Medicare spending annually.

Expanded use of such technology can yield better health outcomes in some cases, but can also produce less tangible benefits such as a patient having more information about a disease or condition. However, it is unclear whether these less tangible benefits justify the costs, the researchers argue. As an example, researchers looked at the use of CT to diagnose conditions affecting the abdominal aorta, particularly abdominal aortic aneurysms. They found that increasing the use of advanced imaging resulted in a few more therapeutic procedures, but that the change was small. The researchers say that the example highlights the challenges of measuring costs and benefits from increased imaging, and that more analysis is needed at the population level.

"We pay for a lot of things that make us happier, but don't necessarily make us healthier," Baker said. "We need to improve our ability to measure the costs and benefits of the dramatic rise in diagnostic imaging we've seen in the past decade."

Explosion In Imaging Rises Among All Patients. The first study to examine use of diagnostic imaging trends in any managed care setting shows how much the use of this technology has exploded in the past decade -- even in a setting where there are no special financial incentives that might encourage providers to use imaging. http://content.healthaffairs.org/cgi/content/abstract/27/6/1491
Rebecca Smith-Bindman of the University of California, San Francisco, and colleagues at Group Health Cooperative examined the experience of enrollees in that large nonprofit health care system, which provides care and coverage to residents of Washington State.

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