Those who want to save funds would do well to apply the actual resource expenditures in rural areas to urban locations. In the US the spread for Medicare was less than $200 per month per patient in rural areas of Nebraska vs some $700 in Miami and New York.
Studies by Wennburg are noting that the major difference seems to be overuse of physicians in urban areas and more visits per patient with no health gain. see Kaiser reference below also see Cost of Care
I look at health expenditures as a "Frank Starling" Heart pump curve. At the lower end or poor health quality, you have great improvement in quality with any increase in expenditure. Eventually the curve flattens and in some cases goes south with too much expenditure.
Quality vs Cost plot
x b
x
x
x
Higher Quality
c
a
x
z
x
Lower
Costs/Expenses/Resources Axis - increasing --- >
A. at point "a" we have some rural and underserved areas, usually those without political clout enough to get what they need. Point a is also common with mental health in some states. Other states have even less expenditure and quality like at point z. At this point almost any increased expenditure would improve quality. Also it is likely that the lack of expenditures is pulling down other related components, for instance lack of mental health resources would impede education and also increase prison and legal and health resources needed (more dimensions than I can show graphically).
B. at point b we have the flat part of the curve where slight increase or decreases in expeditures mean little - this tends to be managed care or governmental care where access and resources are not a problem
C. at point c we have actually too much resources or access and too much is done with a slightly higher chance of a bad result. A possible example is health care for those who work in medical centers.
Ask for equity that all in the province be given the same resources. Be sure to include all sources of health expenditure, including public health which is grossly maldistributed.
One of the Canadian studies on prenatal care noted that the per capita number of physicians was related to better birth outcomes, although most other studies do not show a change in birth outcomes with just about every variable. Might have been Cremieux P-Y Ouellette P Health Care Spending as Determinants of Health Outcomes, Health Economics, 1999, 8:627-39 where a 10 % higher level of spending was associated with .4 to .5 % lower mortality rates
Another is Hanratty MJ Canadian National Health Insurance and Infant Health, American Economic Review, 1996, 86 (1) 276-84 where 10% higher meant 1.5 to 2% lower mortality rates.
More studies on indigent and uninsured and Medicaid at http://www.kff.org/content/2002/20020510/ from Kaiser Foundation study on poor and uninsured, some application to underinsured.
Rural Public Health expenditures report
Rural QA a challenging area when working with a variety of specialists and FP docs
Robert C. Bowman, M.D, Co-Chairman
Rural Medical Educators Group of the National Rural Health Association
UNMC Department of Family Medicine Director of Rural Health Education and Research
983075 Nebraska Medical Center
Omaha, NE 68198-3075
(402) 559-8873 or fax at -8118
Email: [email protected]