The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care

  title={The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care},
  author={Elliott S. Fisher and David E. Wennberg and Thrse Stukel and Dan Gottlieb and Frances Leslie Lucas and toile Pinder},
  journal={Annals of Internal Medicine},
Context Per capita Medicare spending varies considerably from region to region. The effect of greater Medicare spending on quality of care and access is not known. Contribution Using end-of-life care spending as an indicator of Medicare spending, the researchers categorized geographic regions into five quintiles of spending and examined costs and outcomes of care for hip fracture, colorectal cancer, and acute myocardial infarction. Residents of high-spending regions received 60% more care but… 

The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care

The researchers examined costs and outcomes of care for hip fracture, colorectal cancer, and acute myocardial infarction using end-of-life care spending as an indicator of Medicare spending and carried out a cohort study in four parallel populations using a natural randomization approach.

Relationship between regional per capita Medicare expenditures and patient perceptions of quality of care.

No consistent association was observed between the mean per capita expenditure in a geographic area and the perceptions of the quality of medical care of the people who live in those areas.

Area-Level Variations in Cancer Care and Outcomes

Higher-spending areas of fee-for-service Medicare had higher rates of recommended care and preference-sensitive care and had lower lung cancer mortality and in the VA, minimal variation in care by area-level Medicare spending was observed.

Medicare and Medicaid spending variations are strongly linked within hospital regions but not at overall state level.

It is shown that there is almost no relationship between the level of spending for Medicare beneficiaries and that for other populations when considering each state as a whole, and that the strong intrastate regional correlations demonstrate the importance of the supply of hospital beds, specialists, and other health care resources as determinants of use and spending.

Geographic Variation in Medicare Fee-for-Service Health Care Expenditures Before and After the Passage of the Affordable Care Act

It is suggested that antifraud enforcement efforts and payment reforms that were instituted as part of the Affordable Care Act may have reduced geographic variation in Medicare fee-for-service per-beneficiary spending, although significant geographic variation remains.

Dual-Eligible Medicaid Spending: Are We on the Flat of the Curve?

Data from the Medicare Current Beneficiary Survey is used to examine whether increased medical spending results in differential use of medical services and/or improved health outcomes for low-income elderly who are dually-eligible for Medicare and Medicaid.

Medicare Spending Patients ' Preferences Explain A Small But Significant Share Of Regional Variation In

This study assessed the extent to which differences in patients’ preferences across geographic areas explained differences in traditional fee-for-service Medicare spending across Dartmouth Atlas of

The Implications of Regional Variations in MedicareWhat Does It Mean for Medicare?

Fisher and colleagues' findings, if upheld in analyses that include other medical conditions, would provide the best rationale to date for Medicare and the Centers for Medicare & Medicaid Services, the agency that administers Medicare, to drive down spending in high-expenditure areas of the United States.

Comparing local and regional variation in health care spending.

This analysis suggests that HRR-based policies may be too crudely targeted to promote the best use of health care resources and suggests that payment reforms in reducing overutilization while maintaining access to high-quality care depends on the effectiveness of targeting.

Patients' preferences explain a small but significant share of regional variation in medicare spending.

Variation in preferences contributes to differences across areas in Medicare spending, and Medicare policy must consider both supply factors and patients' preferences in deciding how much to accommodate area variation in spending and the extent to which that variation should be subsidized by taxpayers.



The Efficiency of Medicare

It is found that a large component of Medicare expenditures appears to provide no benefit in terms of survival, nor is it likely that this extra spending improves the quality of life.

Trends and Regional Variations in Hospital Use Under Medicare

  • M. Gornick
  • Medicine
    Health care financing review
  • 1982
Perhaps the most surprising finding from this re-examination of regional differences in hospital use is that the number of days of care per capita in one area can differ substantially from that of another area while the per capita costs of care can be nearly equal.

Geography and the debate over Medicare reform.

A new approach to Medicare reform is proposed based on the principles of shared decision making and the promotion of centers of medical excellence and it is suggested that this proposal be tested in a major demonstration project.

Geographic Variation in Expenditures for Physicians' Services in the United States

This work used Medicare claims data for 1989 to measure rates of service use for beneficiaries living in the 317 U.S. metropolitan statistical areas (MSAs) and investigated geographic variation in expenditures for physicians' services.

Physician impact on hospital admission and on mortality rates in the Medicare population.

Physician supply levels and the proportions of specialists and generalists have negligible effects on health status as measured by mortality rates and by rates of admission for all causes and for conditions presumed to be sensitive to the adequacy of ambulatory care.

Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors.

Residence in areas of greater hospital capacity is associated with substantially increased use of the hospital, even after controlling for socioeconomic characteristics and illness burden, and this increased use provides no detectable mortality benefit.

Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries.

Although admission to a major teaching hospital may be associated with increased costs to the Medicare program, overall survival for patients with the common conditions the authors studied was better at these hospitals, especially for Patients with hip fractures.

Hospital readmission rates for cohorts of Medicare beneficiaries in Boston and New Haven.

BACKGROUND Geographic variations in the use of hospital services are associated with differences in the availability of hospital beds. There continues to be uncertainty about the extent to which

A Profile of the Medicare Current Beneficiary Survey

  • G. Adler
  • Medicine
    Health care financing review
  • 1994
The logic, methods, and capabilities of a major new source of data on the Medicare population, the Medicare Current Beneficiary Survey (MCBS), and the analytic strengths of the resulting data are presented.

The effect of managed care on quality: a review of recent evidence.

It is concluded that managed care has not decreased the overall effectiveness of care, and younger, wealthier, and healthier persons were more satisfied with their health plans than older, poorer, and sicker persons, even after adjusting for the type of health plan.