Less is Less — Mississippi

It’s sometimes complicated to explain why published data are incorrectly interpreted.  This short post and the short paper that it was taken from use Mississippi as a case in point.

Does Mississippi really have more specialists and does it spend more on health care than almost every other state, as Baicker and Chandra claim?  Can Mississippi, which ranks near the bottom in health care quality, lift its status by improving its health care productivity, as their Dartmouth colleagues suggest?  If these questions gnaw at you, as they did at me, there’s a need to probe further.

It turns out that Mississippi doesn’t really have an abundance of specialists.  What Mississippi actually has is a high score in a statistical exercise used by the Dartmouth group. But for Mississippians, it’s not a game. Mississippi has the fewest specialists per capita in the Nation. Mississippians have less and they get less.  

And it turns out that Mississippi doesn’t spend more on health care. As is characteristic of analyses by the Dartmouth group, the metric was Medicare, which is not a proxy for spending overall.  As in many poorer states in the south and southwest, Medicare reimbursement in Mississippi is high, but reimbursement from other sources is low.  It’s no surprise that such states have trouble sustaining better quality.  Less leads to less.

The reality is that health care quality is better where there are more physicians (both generalists and specialists) and where communities make greater investments in health care.  There are limits to how much more Mississippi or the nation as a whole can afford, but be assured — more is more, and that makes the policy choices even harder.