Summaries for Patients |

The Implications of Regional Variations in Medicare Spending: Health Outcomes and Satisfaction with Care FREE

[+] Article, Author, and Disclosure Information

The summary below is from the full report titled “The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care.” It is in the 18 February 2003 issue of Annals of Internal Medicine (volume 138, pages 288-298). The authors are ES Fisher, DE Wennberg, TA Stukel, DJ Gottlieb, FL Lucas, and ÉL Pinder.

Ann Intern Med. 2003;138(4):I-49. doi:10.7326/0003-4819-138-4-200302180-00002
Text Size: A A A

What is the problem and what is known about it so far?

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.

Why did the researchers do this particular study?

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.

Who was studied?

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.

How was the study done?

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.

What did the researchers find?

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.

What were the limitations of the study?

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.

What are the implications of the study?

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.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.