December 23rd, 2011 by Richard Cooper, M.D. in Health Policy, Opinion
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There is a romantic view of America as a homogeneous nation – a nation that is flat. But the real America has high peaks of affluence and deep valleys of poverty and a varied landscape of health care spending. It is a hilly terrain of income inequality.
The Affordable Care Act was based on homogeneity. Not only would its provisions be disseminated equally, but smoothing the peaks and valleys of health care utilization would liberate the funds necessary to finance it. Under reform, Newark would come to resemble Grand Junction CO, and Mayo would be the model for Manhattan. No longer would Los Angeles, home to the nation’s largest concentration of poverty, consume more resources than Green Bay, WI, where poverty is infrequent. Regional variation in income and poverty could be ignored all together. The problem is “practice variation,” and health care reform will fix that.
Of course, the US is not homogeneous, and poverty cannot be ignored. In fact, Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
January 10th, 2011 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion, Research
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MedPAC has released another report in which they have tried to explain variation in healthcare utilization among metropolitan statistical areas (MSAs), of which there are approximately 400. MSAs more-or-less correspond to Dartmouth’s 306 hospital referral regions (HRRs), and the conclusions reached by the Dartmouth folks and MedPAC tend to correspond. In commenting about MedPAC’s last report, issued in December 2009, I noted that the major variation was caused by high Medicare expenditures in seven southern states, where patients are poorer and sicker and use much more care.
In their new report, MedPAC went a step beyond measuring expenditures, which they adjusted for prices and other factors in their last report, to measuring the actual units of service, a far better way to assess the healthcare system. MedPAC’s new findings on the distribution of service use in MSAs are graphed below:
Based on this new approach, MedPAC concluded: “Although service use varies less than spending, the amount of service provided to beneficiaries still varies substantially. Specifically, service use in higher use areas (90th percentile) is 30 percent greater than in lower use areas (10th percentile); the analogous figure for spending is about 55 percent. What policies should be pursued in light of these findings is beyond the scope of this paper, which is meant only to inform policymakers on the nature and extent of regional variation in Medicare service use. However, we do note that at the extremes, there is nearly a two-fold difference between the MSA with the greatest service use and the MSA with the least.” Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
December 11th, 2009 by Richard Cooper, M.D. in Health Policy, Opinion
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On the heels of the American Hospital Association’s recent demonstration of gross discrepancies in the Dartmouth group’s data, MedPAC released its December 2009 report to Congress showing the same. Confirming data for 2000 (reported in their 2003 report), MedPAC demonstrated much less variation among states and metropolitan statistical areas (MSAs) than described by Dartmouth for states or hospital referral regions (HRRs). Closer scrutiny of MedPAC’s data reveals even more. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
