Response to Peter Orszag
This is Buz Cooper at his blog:
Peter Orszag….. cited the fact that knee replacements are much more frequent in Milwaukee than in Manhattan, and he's right. But….. Milwaukee's greater use of knee replacements is not because nefarious doctors are bilking the system and that 30% of health care spending could be saved by stopping such waste.
The reason is that Milwaukee is within a cluster of states with high rates. They extend from Idaho to Michigan and from Kansas to North Dakota, but they don't stop there. High rates continue into Saskatchewan, which sits atop North Dakota and has the same high rates, and into Ontario, which sits above Michigan and shares Michigan's high rates. Knee replacement rates in these states and provinces average 70% higher than in regions with the lowest rates….. Saskatchewan and Quebec are as different as North Dakota and New Hampshire. How interesting that two neighboring countries with two different health care systems have identical patterns of geographic variation – a phenomenon that knows no borders…… more.
This is a great article, and points out one of the primary problems regarding comparative effectiveness.
It was interesting that the article referenced over-used of knee replacements in the Upper Midwestern United States. Dartmouth found Medicare expenditures in areas of Florida were twice the spending per senior as Minnesota.
It will be difficult to reduce regional variation in treatments that are ingrained from cultural norms. That is why it is so important for seniors to control more of their own health care dollars. When seniors control more of their own funds, they can decide which services hold value and which ones they consider a waste of money. With little skin in the game, seniors have fewer reasons to question whether invasive treatments might be better treated through drug therapy.
This is very interesting. It’s a perspective I’ve never seen before.