In an article published Feb. 7 on the Health Affairs Web site, Dartmouth researchers Jonathan Skinner, Douglas Staiger, and Elliott Fisher challenge the conventional wisdom that growing health care costs are paying for new treatments and reduced mortality. The Dartmouth trio found that the factors fueling improvement in outcomes for heart attack patients from 1986 through 2002 were not the factors that fueled increases in costs, and much of the improvement occurred in U.S. regions exhibiting below-average growth in spending.

Physician-owned cardiac specialty hospitals take market share from community hospitals, but they don’t appreciably increase the overall number of, or severity mix among, people receiving cardiac surgery, say Jeffrey Stensland and Ariel Winter in the January/February Health Affairs. This could be because surgery is less discretionary than services such as imaging studies and laboratory tests, where physician ownership does increase usage. Or, the researchers warn, it could be because the arms race between cardiac and community hospitals has only just begun.

In a report from the field in the January/February Health Affairs, Nora Super reminds us how pervasively financial incentives can affect physician behavior and how hard it is to say what the "right" incentives are. As Cincinnati Group Health Associates has moved from capitation to fee-for-service payment, GHA physicians have grown more willing to schedule unnecessary office visits and order unnecessary tests. On the other hand, the group now favors sicker patients over soccer moms. GHA physicians say they now have more incentive to get preventive care to those with chronic diseases, although that may be because capitation never put GHA at risk for hospital costs.