For over 40 years, researchers at Dartmouth have conducted small area variation analyses of older fee-for-service Medicare beneficiaries’ use of health care services to explore geographic variation in health care in the United States. Such studies have found substantial variation in use of particular and overall services across geographic regions, that high-cost regions tend to remain high cost over time (Weeks WB. Geographic variation in Medicare expenditures, 2003 – 2012. JAMA Int Med 2016; in press), and that higher spending is not associated with higher care quality or better health outcomes.
A recently released study that examined per-capita costs of care for the privately insured who were aged 18-64 found only a modest correlation of those costs with per-capita costs of patients Dartmouth researchers typically study: for fee-for-service Medicare beneficiaries who were aged 65 and older. That study caused The New York Times reporters to write that Dartmouth Atlas “experts were wrong about the best places for better and cheaper health care.”
But it is important for the Times reporters and their readers to understand some nuances about the study before making such heady statements.
First, as the reporters acknowledge, the study uses only 27 percent of the privately insured. That might not make a difference, as they speculate. But Blue Cross/Blue Shield plans—frequently the most subscribed in a market—were excluded from the analysis. Particularly because the authors of the study argue that hospital market power influences pricing and their results, results might be different if Blue Cross/Blue Shield plans were included.
Second, younger and older patients access health care for different reasons. Younger patients tend to obtain care for pregnancy, trauma, and acute diseases — to be sure, if they have chronic diseases that are disabling, they are put on Medicare roles. Older patients get care for chronic disease management, procedures to stem the tide of aging, and end-of-life care. Seemingly, patient demand drives use by younger patients while medical supply and provider practice patterns drives use by older patients.
Finally, the average per-capita cost for younger patients was about $3,500; that for Medicare fee-for-service beneficiaries was about $9,600. Given the low correlation between the two, overall, combined costs of care would likely be dominated by Medicare costs.
Making the Dartmouth Atlas experts right.
Editor’s note: For more information on this topic, see the Health Affairs Blog post “Making Sense Of Price And Quantity Variations In U.S. Health Care” by Jonathan Skinner, David Goodman, and Elliott Fisher.
from Health Affairs Blog http://ift.tt/1Rqk76Y
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