The Implications of Regional Variations in Medicare Spending: Health Outcomes and Satisfaction with Care. Ann Intern Med. 2003;138:I-49. doi: 10.7326/0003-4819-138-4-200302180-00002
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Published: Ann Intern Med. 2003;138(4):I-49.
Medicare is the public health insurance program for Americans over age 65. Medicare spending in different parts of the United States varies widely. For example, in 1996, the average spending for each Medicare patient was $8414 in Miami and $3441 in Minneapolis. Reasons for this variation include differences in prices, the general health of residents, and the tendency of doctors and patients to use health care services in the various parts of the country. If higher health care spending in a region led to healthier and more satisfied patients, we might think that the money was well spent. If higher spending did not result in these benefits, we would worry about waste.
The researchers wanted to see whether Medicare patients who live in places that spend more on Medicare have better health outcomes or higher satisfaction with health care than those who live in places that spend less.
Using national Medicare data, the researchers studied 614,503 patients hospitalized for hip fracture, 195,429 patients hospitalized for colon cancer, and 159,393 patients hospitalized for heart attacks during 1993–1995. In addition, the authors studied 18,190 typical Medicare patients who had completed a survey. Thus, they studied four different groups of patients.
The researchers divided the United States into 306 regions based on where people go for hospital care. They then calculated how much the Medicare program spent during the last 6 months of life for people who died in each region during July 1994–December 1997. Next, they divided the 306 regions into five groups according to the spending levels. The researchers used end-of-life spending as a measure of general Medicare spending. The researchers then looked at the 5-year death rates for the hip fracture, colon cancer, and heart attack patients. They also looked at patient reports about functional status and satisfaction with care for the patients who completed the survey.
Patients' health status was similar across the five different spending levels, but those who lived in high-spending regions had more frequent doctor visits, tests, and minor procedures and more specialist and hospital care. However, the researchers found no evidence of lower death rates, better functional status, or consistently better satisfaction with care for patients in the high-spending regions.
The researchers looked at a limited number of patient groups and a limited number of measures of functional status and satisfaction with care. It is possible that the results would be different for patients with other conditions or in studies that used other measures of functional status and satisfaction.
For Medicare patients, living in a region with high Medicare spending is not necessarily associated with lower death rates, better functional status, or higher satisfaction with care.
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