The New York Times published a story showing the questionable variation in health care, "Heart procedure is off the charts in an Ohio city."
Elyria, Ohio does coronary angioplasties (often including the use of drug-coated stents to keep arteries open) at four times the national average, three times the rate of Cleveland, just 30 miles away.
This was all found through the valuable Dartmouth Atlas project, which, according to the Times, "also shows that the Elyria doctors have a higher than average tendency to perform diagnostic coronary angiographies on patients — the primary test that is used to detect blockages in the first place. 'People are just geared to be looking at things, and they find them,' said Dr. John E. Wennberg, who pioneered the Dartmouth data analysis."
The Times story concludes: " In the absence of any real monitoring or oversight, doctors in most places, including Elyria, have few incentives not to favor the treatments that provide them the most reimbursement. (A) San Francisco cardiologist said that the way physicians are typically paid — more money for more procedures — results in too many decisions to give a patient a stent.
'You can’t be paying people large sums of money to do things without checks and balances,' he said."