The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care
- PMID: 12585825
- DOI: 10.7326/0003-4819-138-4-200302180-00006
The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care
Abstract
Background: The health implications of regional differences in Medicare spending are unknown.
Objective: To determine whether regions with higher Medicare spending provide better care.
Design: Cohort study.
Setting: National study of Medicare beneficiaries.
Patients: Patients hospitalized between 1993 and 1995 for hip fracture (n = 614,503), colorectal cancer (n = 195,429), or acute myocardial infarction (n = 159,393) and a representative sample (n = 18,190) drawn from the Medicare Current Beneficiary Survey (1992-1995). EXPOSURE MEASUREMENT: End-of-life spending reflects the component of regional variation in Medicare spending that is unrelated to regional differences in illness. Each cohort member's exposure to different levels of spending was therefore defined by the level of end-of-life spending in his or her hospital referral region of residence (n = 306).
Outcome measurements: Content of care (for example, frequency and type of services received), quality of care (for example, use of aspirin after acute myocardial infarction, influenza immunization), and access to care (for example, having a usual source of care).
Results: Average baseline health status of cohort members was similar across regions of differing spending levels, but patients in higher-spending regions received approximately 60% more care. The increased utilization was explained by more frequent physician visits, especially in the inpatient setting (rate ratios in the highest vs. the lowest quintile of hospital referral regions were 2.13 [95% CI, 2.12 to 2.14] for inpatient visits and 2.36 [CI, 2.33 to 2.39] for new inpatient consultations), more frequent tests and minor (but not major) procedures, and increased use of specialists and hospitals (rate ratio in the highest vs. the lowest quintile was 1.52 [CI, 1.50 to 1.54] for inpatient days and 1.55 [CI, 1.50 to 1.60] for intensive care unit days). Quality of care in higher-spending regions was no better on most measures and was worse for several preventive care measures. Access to care in higher-spending regions was also no better or worse.
Conclusions: Regional differences in Medicare spending are largely explained by the more inpatient-based and specialist-oriented pattern of practice observed in high-spending regions. Neither quality of care nor access to care appear to be better for Medicare enrollees in higher-spending regions.
Comment in
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Geographical variations in Medicare spending.Ann Intern Med. 2003 Feb 18;138(4):347-8. doi: 10.7326/0003-4819-138-4-200302180-00015. Ann Intern Med. 2003. PMID: 12585834 No abstract available.
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What's enough, what's too much?Ann Intern Med. 2003 Feb 18;138(4):348-9. doi: 10.7326/0003-4819-138-4-200302180-00016. Ann Intern Med. 2003. PMID: 12585835 No abstract available.
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The implications of regional variations in Medicare--what does it mean for Medicare?Ann Intern Med. 2003 Feb 18;138(4):350-1. doi: 10.7326/0003-4819-138-4-200302180-00017. Ann Intern Med. 2003. PMID: 12585836 No abstract available.
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Implications of regional differences in spending.Ann Intern Med. 2004 Jan 20;140(2):145; author reply 148-9. doi: 10.7326/0003-4819-140-2-200401200-00018. Ann Intern Med. 2004. PMID: 14734340 No abstract available.
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Implications of regional differences in spending.Ann Intern Med. 2004 Jan 20;140(2):145-6; author reply 148-9. doi: 10.7326/0003-4819-140-2-200401200-00019. Ann Intern Med. 2004. PMID: 14734341 No abstract available.
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Implications of regional differences in spending.Ann Intern Med. 2004 Jan 20;140(2):146; author reply 148-9. doi: 10.7326/0003-4819-140-2-200401200-00020. Ann Intern Med. 2004. PMID: 14734342 No abstract available.
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Implications of regional differences in spending.Ann Intern Med. 2004 Jan 20;140(2):146-7; author reply 148-9. doi: 10.7326/0003-4819-140-2-200401200-00021. Ann Intern Med. 2004. PMID: 14734343 No abstract available.
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Implications of regional differences in spending.Ann Intern Med. 2004 Jan 20;140(2):147. Ann Intern Med. 2004. PMID: 14734344 No abstract available.
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Implications of regional differences in spending.Ann Intern Med. 2004 Jan 20;140(2):147-8. Ann Intern Med. 2004. PMID: 14734345 No abstract available.
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Implications of regional differences in spending.Ann Intern Med. 2004 Jan 20;140(2):147. doi: 10.7326/0003-4819-140-2-200401200-00022. Ann Intern Med. 2004. PMID: 14734346 No abstract available.
Summary for patients in
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Summaries for patients. The implications of regional variations in Medicare spending: the content, quality, and accessibility of care.Ann Intern Med. 2003 Feb 18;138(4):I36. doi: 10.7326/0003-4819-138-4-200302180-00001. Ann Intern Med. 2003. PMID: 12585853 No abstract available.
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