Health Affairs

Health Affairs, 28, no. 1 (2009): w119-w123 (Published online 4 December 2008) doi: 10.1377/hlthaff.28.1.w119 © 2009 by Project HOPE	New Online   Getting Health Reform Done   After the State of the Union   Incremental Reform   E-Health in Developing World   Most-Read Articles in 2009

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PERSPECTIVE

The Elusive Connection Between Health Care Spending And Quality

Jonathan Skinner, Amitabh Chandra, David Goodman and Elliott S. Fisher

Richard Cooper has shown a positive association between health care quality and "total spending" at the state level, but he does not appear to understand the limitations of this total spending measure; simply adjusting for median age causes the significant positive correlation to disappear. Cooper also finds that some third factor—we think that it is "social capital"—is the key to explaining health care quality. Cooper may believe that this result challenges three decades of research by the Dartmouth group. Instead, it supports the group’s view that improved efficiency—and not more doctors and hospital beds—is central to improving quality.

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