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Think you're paying too much for health care in your state? You could be right. Some states report significantly higher health costs than others.
Exactly why this is the case often generates discussions about differences in cost of living and average medical salaries. However, a new study conducted by the National Bureau of Economic Research, or NBER, points to another reason for health care cost disparities. You'll probably be surprised by NBER's conclusion from this study.
Cowboys, comforters, and cost
The NBER researchers used patient and physician surveys along with Medicare data to analyze regional differences in spending. Those differences can be quite large. Price-adjusted-per-patient Medicare spending varies from below $7,000 in some areas to nearly $14,000 in others.
Interestingly, most of the expenditure variation isn't due to patients having different types of illnesses in different parts of the country. The variation didn't stem significantly from regional poverty levels, either.
NBER discovered that the single most important factor in accounting for differences in health care spending was physician beliefs that are not supported by clinical evidence. Yep -- how physicians think about treatments accounts for a whopping 36% of end-of-life spending and 17% of total U.S. health care spending.
Physicians responding to the NBER surveys were categorized into different groups. The NBER researchers classified those physicians who consistently recommended intensive care beyond established guidelines as "cowboys." Physicians who consistently recommended palliative care for patients with severe conditions were dubbed "comforters."
The study found that the more cowboys there were in sample data, the higher the spending levels were. Lower spending levels correlated with higher numbers of comforters.
Another highly predictive category of physicians was based on how frequently the doctors recommended follow-up visits compared to clinical guidelines. As you might expect, larger numbers of physicians in the high-frequency follow-up group corresponded with higher medical costs.
When the NBER analyzed data combining cowboys, comforters, and high-frequency follow-up as variables, it found that more than 60% of regional Medicare spending variation was explained. Several other factors, including patient preference for care, were determined to be insignificant.
Basically, the NBER study suggests that physicians who "follow their gut" rather than established clinical guidelines are driving health care costs higher. Geographic regions that have more of these physicians pay more than those that don't. Earlier studies have suggested similar that physicians' views that differ from clinical standards of care could play a big role in higher costs, but none has directly established the correlation between physician beliefs and Medicare spending.
What could this conclusion mean for the U.S. health care system? And, since we at The Motley Fool are always looking at things from an investing angle, what are the implications for individual investors?
Certainly, one study by itself won't result in radical changes. However, if further research supports the NBER findings, there could be a push to more stringently enforce clinical guidelines in how physicians treat patients.
UnitedHealth Group (NYSE: UNH ) stands to be a beneficiary of any such efforts in a couple of ways. First, as the nation's largest insurer, the company would incur lower medical expenses (and thereby more profit) if regional spending differences were minimized. Second, UnitedHealth's Optum business segment could be a significant player in the arena of helping health care providers implement processes and systems that follow clinical guidelines.
Another potential winner is athenahealth (NASDAQ: ATHN ) . The cloud-based physicians software company already incorporates clinical rules into its workflow. Fast-growing athenahealth also snagged the top ranking from health-care research firm KLAS in June for physicians' electronic medical record system usability, efficiency, and effectiveness.
Looking down the road a bit, IBM (NYSE: IBM ) could reap rewards from any efforts to standardize how physicians treat patients. Big Blue plans to deploy its Watson technology to help clinical professionals diagnose and treat patients. Watson uses "natural language capabilities, hypothesis generation, and evidence-based learning" to assist in decision-making.
The ink on the NBER report has barely dried. It could be a while before the ramifications of the study's conclusions work their way through the circles that make decisions about health care reimbursement. However, my hunch is that we'll hear much more in the future about the importance of ensuring standard clinical protocols are followed by physicians. This should be a developing story that investors will want to follow closely.
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