In this issue, Fisher and colleagues (1 - 2) have provided compelling evidence that 5-year mortality rates, functional status, and quality of care for three conditions (acute myocardial infarction, hip fracture, and colorectal cancer) do not vary significantly from high-cost to low-cost hospital referral regions (HRRs). Costs varied primarily by the number of consultations, tests, and hospitalization days rather than by the evidence-based services required. If anything, mortality rates were somewhat greater in the highest-cost areas. There was wide variation in use of intensive care unit beds, emergency intubations, and feeding tubes during the last 3 years of life. Influenza and pneumococcal immunizations and Papanicolaou smears were performed less frequently in regions with higher expenditure indexes. Patients in areas with higher expenditure indexes were more likely to see medical subspecialists, and those in HRRs with lower expenditure indexes were more likely to see family practitioners. Although the differences are small, the authors point out some evidence that access to care was poorer in higher-expenditure areas.