NCPA - National Center for Policy Analysis

Chronic Disease Diagnosis May Depend on Where You Live

March 25, 2011

The likelihood of Medicare patients being diagnosed with a chronic disease may depend on where they live -- a disparity that makes it more difficult to assess the quality of care patients receive, a new study finds.  Certain groups of Medicare patients in regions with the most diagnoses also had a lower case-fatality rate for chronic conditions such as coronary artery disease and kidney failure, but the reasons for that are unclear, says America's Health Insurance Plans (AHIP).

Findings suggest that chronic disease diagnosis is influenced by the "intensity of health care" in a particular region, which includes how many doctors and specialists are operating in a particular region, access to those doctors and the likelihood of doctors to send you to a specialist or to order lab and imaging tests.

  • Researchers analyzed records on nearly 5.2 million Americans aged 65 and up who received fee-for-service Medicare benefits in 2007.
  • In particular, they examined data on diagnoses of nine serious chronic conditions: cancer, chronic obstructive pulmonary disease, coronary artery disease, congestive heart failure, peripheral artery disease, severe liver disease, diabetes with end-organ disease, chronic renal failure and dementia.

Put simply: a patient diagnosed with heart disease and diabetes would be sicker than a patient with only one condition, but whether they are diagnosed with both may be more related to where they live and how many doctors they see, says AHIP.

Source: Jenifer Goodwin, "Whether Chronic Diseases Are Diagnosed May Depend on Where You Live," America's Health Insurance Plans, March 16, 2011.  H. Gilbert Welch et al., "Geographic Variation in Diagnosis Frequency and Risk of Death Among Medicare Beneficiaries," Journal of the American Medical Association, March 2011.

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