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

@article{Fisher2003TheIO,
  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},
  year={2003},
  volume={138},
  pages={273-287}
}
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

TLDR
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.

TLDR
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

TLDR
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.

TLDR
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

TLDR
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?

TLDR
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?

TLDR
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.

TLDR
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.

TLDR
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.
...

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