NCPA - National Center for Policy Analysis

Surgery? Depends on Where You Live.

March 1, 2011

For Medicare patients with conditions for which surgery is an option, whether they undergo elective surgery depends largely on where they live and the clinicians they see.  Researchers Shannon Brownlee and David C. Goodman found there is remarkably wide regional variations in elective surgery for Medicare patients even when they have similar conditions.

  • Men over age 65 with early-stage prostate cancer who live in San Luis Obispo, California, are 12 times more likely to have surgery to remove their prostate than those in Albany, Georgia.
  • Medicare patients with heart disease in Elyria, Ohio, are 10 times more likely to have a procedure such as angioplasty or stents than those in Honolulu, Hawaii.
  • And women over age 65 living in Victoria, Texas, are seven times more likely to undergo mastectomy for early-stage breast cancer than women in Muncie, Indiana.

"In highlighting the variation from community to community for elective procedures, we hope to shine a light on the fact that patients' preferences are not always taken into account when medical decisions are made," say Brownlee and Goodman.

  • All too often, patients facing elective surgery are not given an opportunity to learn about the full range of options, and that each choice has unique risks and benefits.
  • Many are not even aware that the decision about an elective procedure is actually a choice.
  • Instead, they routinely delegate such important decisions to their clinicians, with the result being that patients often do not get the treatment they would prefer.

Source: Shannon Brownlee and David C. Goodman, "When It Comes to Elective Surgery, Location Matters," Dartmouth Atlas, February 24, 2011.

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