The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care

The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care

From Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire; VA Outcomes Group, White River Junction Veterans Affairs Medical Center, White River Junction, Vermont; and the Institute for the Clinical Evaluative Sciences, Toronto, Ontario, Canada.

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Figure 1. EOL-EI = End-of-Life Expenditure Index; HRR = hospital referral region; Q1 = quintile 1; Q2 = quintile 2; Q3 = quintile 3; Q4 = quintile 4; Q5 = quintile 5. Overview of study design.
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Figure 2. Average per capita Medicare spending, health care resource levels, and other key attributes of U.S. hospital referral regions according to quintiles of spending.
$Figure 3. MCBS = Medicare Current Beneficiary Survey; MI = myocardial infarction. The graph presents unadjusted annual per capita spending on hospital and physician services (using standardized national prices) for each cohort in each quintile of the End-of-Life Expenditure Index. Data shown for the acute myocardial infarction, colorectal cancer, and hip fracture cohorts exclude the first 6 months of follow-up. *Relative rate of utilization in quintile 5 compared with quintile 1, adjusting for baseline differences in patient characteristics. Values in parentheses are 95% CIs.$
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Figure 3. MCBS = Medicare Current Beneficiary Survey; MI = myocardial infarction. The graph presents unadjusted annual per capita spending on hospital and physician services (using standardized national prices) for each cohort in each quintile of the End-of-Life Expenditure Index. Data shown for the acute myocardial infarction, colorectal cancer, and hip fracture cohorts exclude the first 6 months of follow-up. *Relative rate of utilization in quintile 5 compared with quintile 1, adjusting for baseline differences in patient characteristics. Values in parentheses are 95% CIs. Per capita utilization of hospital and physician services during follow-up by study cohorts.
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Figure 4. Utilization is summarized as unadjusted average annual per capita spending on physician services (using standardized national prices, as described in the Methods section). *Categories defined by using the Berenson–Eggers type of service classification scheme. Utilization of physician services across quintiles of spending for the Medicare Current Beneficiary Survey cohort, 1992–1996.
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Figure 5. CIs for office visits, inpatient visits, new inpatient consultations, and inpatient days were narrower than the diameter of the circle used to indicate the point estimate. CT = computed tomography; ICU = intensive care unit; MRI = magnetic resonance imaging. Relative rate and 95% CIs of specific services provided to cohort members residing in the highest quintile of Medicare spending compared with those residing in the lowest quintile for the three chronic disease cohorts combined.
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Figure 6. Arrows show the direction of any statistically significant association ( ≤ 0.05) between the percentage of patients receiving a specified service and regional End-of-Life Expenditure Index differences. An arrow pointing upward indicates that as spending increases across regions, the percentage of patients receiving a specified service increases. A value greater than 0.05 was considered not significant. Percentage of patients in the acute myocardial infarction cohort who received the specified therapy (among ideal candidates), according to type of hospital and quintile of Medicare spending.PP