A study of doctors and clinics that care for many Medicaid patients in Maryland has found that the lowest-cost providers are not necessarily the worst, nor are the most expensive the best.
When it comes to the overall health of patients, researchers at the Johns Hopkins School of Hygiene and Public Health and the state health department found that there was really no relationship between cost and quality of care.
The findings suggest that policy-makers don't have to compromise care in their zeal to trim expenses -- as long as they monitor the work done by providers.
"The implication of this is that basically the payer has to monitor care -- you can't make predictions about quality based on cost," said Dr. Barbara Starfield, a Hopkins profes- sor of health policy and the study's lead author.
This year, the state is spending about $1.4 billion on Medicaid.
Although the study appears in today's Journal of the American Medical Association, the findings have already triggered a state effort to identify low-cost medical practices that provide good care.
In that program, begun last summer, consultants at the University of Maryland Baltimore County are drawing up a list of low-cost, high-quality practices to which Medicaid recipients can be assigned. In analyzing providers, the consultants are using the same techniques used in the study.
Costs included doctors' fees as well as associated bills for tests, hospital admissions and referrals to specialists.
Quality was measured in several ways.
"The kinds of things they were looking for . . . was whether a doctor was doing the right types of preventive care for a diabetic or an asthmatic child," said Mary Stuart, director of policy and health statistics for the state health department. "They were looking for quality measures for child preventive care, prenatal care and chronic conditions."
Hopkins and health department researchers, who analyzed more than 2,000 patient records, checked to see if doctors monitored the blood levels of asthmatic children placed on medication and if they tracked the blood-sugar of diabetics. The researchers also considered how frequently patients developed preventable complications and had to be hospitalized.