Maine Town Sheds Light On Doctors' Role In Cost Problem

Nobody will make much progress in taming health-care spending in this country without getting doctors on board.

A view of downtown Lewiston, Maine.

A medical mystery unraveled in Lewiston, Maine. NPR/John W. Poole hide caption

itoggle caption NPR/John W. Poole

In the first installment of a series on escalating health costs, NPR's Alix Spiegel takes a look at the curious case of Lewiston, Maine, where back in the 1970s so many women were getting hysterectomies that 70 percent of female residents were likely to have had one by the time they reached 70. In a nearby town the hysterectomy rate was more like 25 percent.

How come? The big difference wasn't the patients, it was the doctors. The ones in Lewiston recommended hysterectomies far more often than their peers elsewhere.

Spiegel talks with Dartmouth's Jack Wennberg who's made a life's work out of mapping differences in care and cost all over the US. Thirty years ago his work helped doctors in Maine bring evidence, rather than personal preferences or the profit motive, to bear on their decision-making.

Over the years, the essential finding by Wennberg and his proteges is that more care doesn't necessarily translate into better outcomes for patients. But more care is more expensive.

Of the $2 trillion-plus spent on health care in this country each year, about 30 percent, or $660 billion is wasted.

What hit Spiegel hardest in her reporting? "What was totally counterintuitive was that more care wasn't necessarily better," she told us. "That's tough for American, including me, to accept."



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