Brookings Institution study upends Dartmouth Atlas assumptions

A new report by the Brookings Institution questions previous studies that delve into the vast differences in healthcare spending in different regions of the country.

The study questions the previous assumptions set by the ongoing Dartmouth Atlas study, which had concluded that variations in Medicare expenditures were due to differences in the way doctors practiced medicine based on large swathes of geography. By contrast, the Brookings Institution study focused on the state level and the demographic differences between different populations.

The conclusion: "Geographic variation in health spending does not provide a useful way to examine the inefficiencies of our health system."

Indeed, the state-level Brookings research found few differences in spending. According to the researchers, it is not surprising that states such as Louisiana and Mississippi, which have a large number of residents who are obese and in poor health, experience higher rates of Medicare spending than mountainous states, which tend to have healthier residents. But after controlling for these factors, the differences in spending are less pronounced.

"In fact, states that appear to be high-cost, like Florida and Connecticut, are no longer big healthcare spenders once demographic and health variables are controlled for, just as states that appear to be low healthcare spenders like Utah and Vermont are actually relatively high spenders once those adjustments are made," according to the report's summary. "These results suggest that the cross-state variation in Medicare spending is tightly associated with the characteristics of state populations, and that once these characteristics are controlled for, the variation in spending is fairly small."

By contrast, the Dartmouth Atlas data have focused not only on physician practice patterns, but on other ancillary issues such as patient preferences, which a recent Health Affairs study concluded could contribute more than $2,000 a year to a single patient's costs. But some have criticized the Dartmouth Atlas for focusing on costs to the exclusion of patient outcomes.

To learn more:
- check out the Brookings Institution study