Dr. Ateev Mehrotra of the University of Pittsburgh and colleagues said there is broad policy consensus that both cost containment and quality improvement are critical but the association between cost and quality is poorly understood.
The researchers used PubMed, EconLit, and EMBASE databases for studies based in the United States and published from 1990 to 2012 to conduct a systematic review of evidence of the association between healthcare quality and cost.
Of 61 studies, 34 percent reported a positive or mixed-positive association -- higher cost associated with higher quality -- 30 percent reported a negative or mixed-negative association; and 36 percent reported no difference.
The study, published in the Annals of Internal Medicine, found evidence that most studies determined the positive or negative direction reported in the association between cost and quality was small to moderate, and was inconsistent.
Future studies should focus on what types of spending were most effective in improving quality and what types of spending represent waste, Mehrotra said.