Controlling Health Costs: Provide Care More Like Duke Hospital

With all the talk about controlling health care costs, I thought it would be good to take yet another look this afternoon at the huge regional variation in how much we spend on health care and how aggressive we are in treating patients. (Data and reports are from the Dartmouth Health Atlas).

Compare our own Duke University Medical Center with another excellent hospital, Cedars-Sinai Medical Center in Los Angeles. Look at spending on similar Medicare patients in the last two years of life and you find some major surprises:

1. Duke spends roughly half per Medicare patient than does Cedars-Sinai ($57,411 at Duke v. $106,951 at C-S).

2. A patient at Duke will spend about half the time in the hospital than if they were at Cedars-Sinai (13.75 days v. 24.41 days at C-S).

3. A patient at Duke will have only 1/3rd of the physician visits at patient at Cedars-Sinai will experience (24.14 visits v. 79.34 visits at C-S).

The difference is not due to any variation in the illness, the preferences of patients, or science being different in LA v. Durham. All patients are insured through Medicare, all are all living through the last two years of their lives, and all are being treated at one of the top medical centers in the country. All patients have similar health outcomes and are similarly satisfied with their care.

As the Dartmouth researchers have repeatedly demonstrated, this enormous variation in the cost and aggressiveness of treatment is due to physician preferences between the two hospitals.

Put simply, Duke in Durham is delivering world-class care at roughly half the cost of some of the other top medical centers in the US. Not that Duke doesn’t have room for improvement. Some other centers deliver great care at even lower cost, but even so, if we could simply provide care in the same way across the country that Duke provides care here in Durham we would begin to address of health care cost problem.


  1. Alex

    October 24, 2009 at 5:06 pm

    That is because Duke charges other people with insurance a lot more. Last year I had a Lumbar Puncture at Durham Regional out patient $12,000. I had to wait two hours days before for routine blood work. I had an appointment for the procedure and had to wait Three hours. I never saw the Doctor the day of the procedure. I wonder if he was really there. I had an eeg at Durham Regional this year over a $1,000. Five years ago I had an out patient yearly physical with out a mammogram over $3000. I was charged $ 900 for one blood test. I do not use Duke for primary care anymore . I had a kidney stone removal at Duke. They put two arm bands on me and could not find the tests and did them all twice and charged me double for all procedures. I was there all day and the Doctor forgot to get me to sign surgical consent until I was under anesthesia. I tell my husband if there is an emergency do not take me to any Duke Hospital. It is first class prices for third class care.

  2. Adam Searing

    October 24, 2009 at 6:50 pm

    Alex – the sad thing is that those sorts of prices are now routine at hospitals around the country. In addition, confusion, overcharging patients who don’t have insurance, and lack of coordination are too often the order of the day.

    By standardized measurements, Duke does a pretty good job. That’s what the Dartmouth data shows. But the problems you focus on are endemic to are whole system. We need transparency in pricing, electronic medical records, and a slew of other changes, starting with simply covering everyone with a decent plan no matter what.

  3. Lou Meyers

    October 25, 2009 at 2:58 pm

    Cost around the country are not just high —- they’re insane!

    Let’s take an MRI for instance. In the US, it’s around $1,400.
    In Taiwan, using the most advanced machines in the world, it’s about $80.

    Due to advances in technology — computers, LCD monitors, RAM etc. are all much cheaper now. One meg of memory was $1000 in 1988. Now it’s 2 and a half cents! An MRI was around around $1000 in 1988, yet the cost to patients has not dropped — it’s increased. Why do they charge us this? Because they can!

    If your kid needs an MRI, you’d give them your house if you had to.
    They know this, so they gouge you. It’s that simple.

  4. Joan Halgren

    November 4, 2009 at 9:23 pm

    Grand Junction, CO does one of the best jobs in the nation, in part, because the docs have agreed on pricing no matter the source of payer! Additionally, the abide by the same protocols.

  5. […] health outcomes. For example, Duke University Hospital is delivering great health care at nearly half the cost of the most expensive health systems in the country. There’s a variety of reasons for this […]

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