NCPA - National Center for Policy Analysis

Why Do Medical Treatments Differ Geographically In The U.S.?

March 21, 2002

Dartmouth College physician John Wennberg believes there is little scientific basis for the differences in the ways medicine is practiced across the U.S. and little evidence that giving more care always extends lives. He believes we could save a lot of money if we figured out what care is valuable and what is not -- and provided more of the first and less of the second.

Here are a few examples of the disparities in medical treatment he has unearthed:

  • A typical 65-year-old in Miami, Fla., will cost Medicare $50,000 more in his or her lifetime than a 65-year old in Minneapolis, Minn.
  • Three of every 1,000 Medicare beneficiaries undergo heart bypass surgery each year in Albuquerque, N.M., but 11 in 1,000 do in Redding, Calif.
  • Only 14 percent of the terminally ill in Sun City, Ariz., enter an intensive care unit in the last six months of their lives, but 49 percent do in Sun City, Calif.
  • Elderly men in Binghamton, N.Y., are nine times more likely to have their prostate removed than men of the same age in Baton Rouge, La.

The research highlights two facts about American health care. The first is ignorance - we still know little about which treatment for some maladies is best. The second is the focus on cost rather than quality - decades of tinkering with Medicaid and managed care were aimed mainly at saving money.

Wennberg suggests that government, insurers and employers move to paying doctors and hospitals based on the quality of care they provide -- not the quantity.

Source: David Wessel, "Capital: The Medical Mystery of Sun City," Wall Street Journal, March 21, 2002.


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