Schwitzer health news blog

New Dartmouth Atlas of Health Care released

Medicare rewards the inefficient and gets worse results for paying more. That's one of the conclusions you could draw from the new edition of the Dartmouth Atlas of Health Care: Tracking the Care of Patients with Severe Chronic Illness.

The new Atlas report shows that institutions that give better care can do it at a lower cost because they don’t over-treat patients. However, the Atlas documents that Medicare and most other payers encourage the over-use of acute-care hospital services and the proliferation of medical specialists thanks to misplaced financial incentives, especially for treating chronically ill people.

Examples from the new Atlas:
An elderly person spent an average 10.6 days in the hospital during the last two years of life in Bend, Ore., but 34.9 days in Manhattan.

The variation is even more striking in the last six months of life, when chronically ill patients visited the doctor an average of 14.5 times in Ogden, Utah, compared to 59.2 times in Los Angeles, Calif.

That creates wild variations in how much Medicare spends on these patients. The U.S. average was $46,412. The highest spending was in New Jersey at $59,379 per patient, or a quarter more than the average. The lowest was in North Dakota at $32,523 per patient, or a quarter less than the average.

The Atlas is one of the most important documents in U.S. health policy. It paints a picture of the "non-system" we have built. And it has direct implications for health care consumers, who must realize the variations in practice reflect uncertainties about what is the "right" care or the "best" care for them.

Our own work on HealthNewsReview.org - grading health news coverage of new treatments, tests, products and procedures - is based on the same theme. Journalists must do a better job of conveying the uncertainties that exist in health care - the tradeoffs that come with any health care decision. They must scrutinize the quality of the evidence, quantify harms and benefits, and discuss costs. Or else they're conveying a "kid-in-the-candy-store" picture of U.S. health care that contributes to the picture described above.