Geographic correlation between large-firm commercial spending and Medicare spending.

摘要: Considerable research has documented variation in healthcare spending across geographic areas.1,2 For example, Martin et al3 reported striking health the United States, with nearly a twofold difference personal between highest- and lowest-spending states 2004; per capita Massachusetts was $6683 while Utah it only $3792. Notably, Medicare program, areas higher have not been found to better healthcare. Baicker Chandra4 that quality of care were inversely related for national sample beneficiaries. This reflects substantial differences practice patterns. considerable frequency discretionary procedures such as hip, knee, spine surgeries beneficiaries reported.5 Likewise, several studies identified marked treatment patients acute myocardial infarctions (eg, use noninvasive vs invasive management strategies).6-8 Fisher al9 studied quantity delivered chronically ill frequencies hospitalization, diagnostic testing, physician visits varied by geography system used patients. The explained regional illness levels or patient preference, suggesting market factors local opinion supply medical resources may play prominent role defining patterns. Research on variations patterns very influential, but most focused spending.1,10,11 Although is large important currently covering about 45 million beneficiaries, majority individuals States are insured through commercial plans. Policy conclusions stemming from Medicare-based often implicitly assume insurers strongly related. Indeed, suggest should be positively correlated markets. physicians likely similar styles age groups same disease.12,13 In addition, extent prices reflect common costs wages, different populations. Some existing empirical evidence at hospital level suggests positive correlation utilization inpatient care.14 yet there also reasons why growth differ areas. First, prevalences disease conditions differ, leading services delivered. payers pay childbirth, which relevant over-65 population. contrast, home much less frequent population than Even diseases afflict both populations heart disease) treated differently an opposed under-65 who commercially because comorbidities frailty. Further, benefit packages differ. Prior 2006, did cover orally administered drugs, whereas vast firms did. Second, reimbursement methods traditional relies price few administrative controls use. negotiate rates providers. this reason we would expect effects provider competition vary insurers. Finally, although long-term sectors similar, any given year picture If tightens reimbursement, hospitals competitive markets seek carriers joint costs.15 This study documents (a subset spending) compares firm referral regions (HRRs). number reasons, plan type generosity, data strictly comparable. It recognize associated high rate growth.16,17 researchers examining impact maintenance organizations (HMOs) high-deductible plans noted these lead “one time” savings reduce point time, substantially alter trajectory spending.18-21