The crazy quilt of health care in the US


If you want to get a picture of the crazy quilt of US health care, take a look at the new Dartmouth Atlas Project report.

It shows that:

Medicare spending is rising more than twice as fast in Dallas as in San Diego.

Medicare is spending nearly three times more on seniors in Miami than in Honolulu.

In the image below, Wausau, Wisconsin is shown with rapidly rising Medicare costs amidst a sea of otherwise lower-spending Midwest hospital regions. Why?

new Atlas Wausau.png

Or you can go to this full interactive scroll-over-your-region map.

A news release accompanying the report says:

“This illustrates how huge inefficiencies in the U.S. health care system are hamstringing the nation’s ability to expand access to care.

The authors argue that the differences in growth are largely due to discretionary decisions by physicians that are influenced by the local availability of hospital beds, imaging centers and other resources—and a payment system that rewards growth and higher utilization."

“To paraphrase a line from the gun control debate: technology doesn’t drive the growth in health care spending; people do,” said lead-author Dr. Elliott Fisher, principal investigator for the Dartmouth Atlas Project and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice. “The good news is that in many regions, spending is growing relatively slowly. Reformers can learn from these regions and put in place policies that help them sustain what they are doing now, and encourage high-cost, high-growth regions to change their ways.”

“This work demonstrates why health reformers should work to realign private and public payment schemes to benefit quality performance over the volume of services,” said Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. “Clinicians who successfully provide high quality care and slow spending growth should be rewarded, not penalized.”

“This is an opportunity for physicians to lead,” said Dr. Julie Bynum, co-author and assistant professor of Medicine at Dartmouth Medical School. “But even though doctors still make most of the critical decisions about how and where their patients get care, they will need help from payers and policymakers. Physicians operate under the rules of a system that is rigged to reward high-cost care.”

More maps are available online.

So is the study, published in the New England Journal of Medicine.

There's an important message for consumers here. This isn't just academic policy wonk talk. Health care consumers need to know that there's tremendous variation in the way health care is practiced in this country. There is tremendous uncertainty about best practices and best treatments. And - repeat after me -



Do you think that some of this is due to M'care paying at different rates around the country? The reimbursement is not equal for doctors and hospitals around the country.


As you probably know, that same Dartmouth Atlas project has shown us the wide variations in Medicare reimbursement across the country.

But - to your question - it doesn't entirely explain rate of spending increase.

And it doesn't explain pockets like the one I highlighted - of Wausau, Wisconsin - an island of hot spending increase in a region otherwise noted for having among the lowest Medicare costs and cost increases in the U.S.

About this Entry

This page contains a single entry by Gary Schwitzer published on February 28, 2009 9:55 AM.

Call for more facts on magazine drug ads was the previous entry in this blog.

The scan scam is the next entry in this blog.

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