New Study Disputes Dartmouth Findings

Widespread regional variations in health care spending, documented by researchers at Dartmouth, suggest that there is much waste in high-spending areas. If so, billions of dollars could potentially be saved by simply changing the way medicine is practiced.

But a new paper by Louise Sheiner, an economist at the Federal Reserve, concludes that health and socioeconomic factors—e.g., the prevalence of smoking, obesity and diabetes—best explain why health spending in some regions of the country is higher. That view has been argued for years by researchers such as Dr. Richard “Buz” Cooper of the University of Pennsylvania.

NCPA Senior Fellows, Andrew Rettenmaier and Thomas Saving have also found other reasons for the geographic variations in medical spending.

Comments (9)

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  1. Ken says:

    Good to see this sort of work.

  2. Greg says:

    Good to see the rest of the story.

  3. Tyrus says:

    At least there are people to double check these sorts of things!

  4. Devon Herrick says:

    NCPA Senior Fellows, Andrew Rettenmaier and Thomas Saving word their narrative in a diplomatic way.

    One point I gleaned from their paper is that using the Dartmouth Atlas as an efficiency measure is oversimplifying the problem.

    [T]he same pattern of regional variation observed for Medicare spending does not necessary hold when other measures are used.

    The reliability of this particular data set vis-a-vis the Dartmouth Atlas Medicare-based data has been called into question by Skinner, Chandra, Goodman and Fisher in a 2009 Health Affairs article.

    They also find that Medicaid substitutes for Medicare and vice versa.

    …significant resorting that occurs when Medicaid is ranked in terms of the population covered by the program. In fact, the two ranking are negatively correlated…

    This comparison indicates the interplay and tradeoffs states make in determining eligibility criteria and Medicaid benefit generosity.

    In addition, some other reasons there are geographic variations in Medicare spending including the uninsured.

    …geographic variation is multi-dimensional and defining this variation by any one of these measures alone would lead to quite different policy suggestions.

    As expected, a higher uninsured rate is associated with lower state health care spending in the non-Medicare/Medicaid population. In contrast, a higher percent of the population with no insurance resulted in higher Medicare spending per enrollee indicating cost shifting to Medicare.

  5. Greg Scandlen says:

    But it isn’t just smoking and obesity either. Other sociological factors are crucial, such as the support of intact families, being affiliated with community and religious organizations, working in satisfying jobs, living in appropriate housing, etc.

    We have to get beyond treating patients as nothing more than a collection of symptoms. They (we) are fully-realized human beings with a vast range of resources, emotions, and abilities. Health care researchers NEVER get this.

  6. Thomas says:

    Dartmouth sounds legit.

  7. Gabriel Odom says:

    When I was helping with cancer cluster analysis in the State of Florida, we didn’t just assume that higher cancer rates in a particular location were do to something as external as “inefficiency”.
    The fact that Dartmouth researchers have so little treatment in proper statistical methods disturbs me deeply.

  8. H. James Prince says:

    From the NCPA study by Rettenmaier and Saving:

    “Even if it were possible to transform the style of practice for the Medicare population in a way that was costless and achieved the suggested reduction in Medicare expenditures, would such a change equalize general health care expenditures across states? Such a result depends on the assumption that Medicare expenditures and general health care expenditures are closely related. However, the same pattern of regional variation observed for Medicare spending does not necessary hold when other measures are used.”

  9. Bob Hertz says:

    This is important material, but I am getting a little confused.

    What I thought the Dartmouth studies were saying was that middle class seniors in Miami were running up twice the Medicare costs vs. middle class seniors in Sioux Falls or Minneapolis, and it was all due to having too many specialists and ICU beds in Miami.

    Now this blog exchange gives me the impression that it is poor seniors in Miami who are causing the higher expenditures.

    Am I missing something? It would not be the first time.