A leading national health expert told Utah government and health leaders Thursday that more isn't necessarily better when it comes to health care. He presented data showing Utah as one of the top states giving high-quality health care for less money.

"You don't have to step back very far from the U.S. health-care system today ... to get a sense that we've got a problem in health care," said Dr. Elliott Fisher, a professor of medicine at Dartmouth Medical School and director of the Institute for Health Care Research and Reform in Dartmouth's Center for the Evaluative Clinical Sciences. He spoke during a luncheon in downtown Salt Lake City.

The gathering was part of a series of discussions Intermountain Healthcare is sponsoring to discuss health-care challenges.

Fisher said that he was surprised when he found that areas in the nation that had higher health-care spending actually rated poorer in quality than lower-spending areas.

He called it "the paradox of plenty," saying more equipment and more physicians don't result in healthier patients.

Greg Poulson, senior vice president at Intermountain Healthcare, said Fisher's idea may run counter-intuitive to what is normally thought.

"I think a lot of people just assume more health care is better," he said several hours after the luncheon.

Poulson said that Utah has led the nation for years in low health-care costs and that physicians in the state tend to be more conservative in using resources and "considerate in recognizing the costs of care."

Fisher took part in a study released last year that said Salt Lake City was a model for other areas of the nation in terms of health care.

Other "looming challenges" Fisher said the industry is facing are the collapse of primary care and the loss of academic credibility and professional authority of physicians.

He called the industry's current payment system "toxic."

"I think there's a growing recognition among leaders, even the leaders in medicine, that the entrepreneurial focus of our current payment system is at least in conflict (with) if not undermining the values of the profession," Fisher said.

Fisher praised Intermountain Healthcare for its efforts to monitor the quality of the health care that it provides.

He said progress in health care will probably come with more local efforts.

"I believe in the current health-care environment, it's at the state level that some of the most progressive things are likely to happen and some of the greatest creativity is likely to emerge."

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E-mail: bcaballero@desnews.com