Health care is an important, but rising, expense. In fact, it is estimated that by 2011, the per person spending for health care will increase by 49%—reaching as high as $9,216. Spending varies widely by region. For example, spending for traditional Medicare in the Minneapolis region in 1996 was $3,341 per enrollee versus $8,414 in Miami.

Interestingly, this disparity is not due to regional differences in the prices of medical services or illness levels. Instead, studies have shown that the higher cost is related to the overall quantity of medical services provided and to the relative predominance of internists and medical subspecialists. Evidence suggests that the more subspecialists that are available, the more they will be used.

It is not known, however, if Medicare enrollees who live in regions with higher Medicare spending get better quality of care than enrollees who live in regions with lower Medicare spending. Nor is it clear whether or not they have better access to care.

In a study published in the February 18, 2003 Annals of Internal Medicine , researchers found that Medicare enrollees in higher-spending regions did not get better quality of care or access to care.

About the study

The study population consisted of patients between the ages of 65 and 99 who were hospitalized between 1993 and 1995 for one of the following conditions:

In addition, a general population sample (18,190) was drawn from the Medicare Current Beneficiary Survey (1992-1995).

The researchers assigned each of the 306 US Hospital Referral Regions (HRRs) in the US to one of five quintiles of spending based on the End-of-Life Expenditure Index, which uses end-of-life care as an indicator of Medicare spending. The geographic regions of the patients in the study were categorized into one of these five quintiles.

The study participants were followed for five years. Each patient type in each spending quintile was compared against similar patient types in different spending quintiles for processes of care, including:

  • Content of care - for example, frequency and type of services received
  • Quality of care - for example, use of aspirin after heart attack, influenza or pneumonia immunization, Pap smears
  • Accessibility of care - for example, having a usual source of care

The findings

Residents of the highest spending regions (quintile 5) received 61% more Medicare resources than those in the lowest spending regions (quintile 1). Differences in spending were largely due to more frequent use of the hospital as a site of care, more frequent physician visits, greater use of medical specialists and more frequent diagnostic tests and minor procedures. However, the overall rate of major surgery was relatively constant across quintiles.

Regions with higher per person spending did not provide better quality of care on most measures. In fact, some preventive measures, such as the Pap test and influenza vaccination, were performed less frequently in the highest spending regions.

When researchers looked at access to care, they found that although the absolute differences were small, the higher quintile regions had a general pattern of slightly lower access to care. For example, patients with acute heart attacks who lived in the higher spending regions were significantly less likely to receive ]]>exercise testing]]> and ]]>angiography]]> , or to see a physician within 30 days of discharge.

Although these results are interesting, there are limitations to this study. The researchers looked at a limited number of measures of quality and access of care. In addition, only four groups of patients were included in the study. The study's authors note that there is the potential for unmeasured differences in health status that could affect the outcome. They also point out that state-level differences in malpractice environments may have an impact on the differences in practice that were observed.

How does this affect you?

This study has potentially far-reaching implications for health care spending. For example, the findings could be used to justify a "reigning in" of resource allocation in high-spending areas.

There is also a salient message for you, the health care consumer. Whether you live in a higher-spending community or a lower-spending community, your health care has the potential to be first rate.

To help ensure that you get the best care possible, work closely with your doctor. Educate yourself about your condition, ask questions, and take part in your treatment. In other words, it’s important to become an advocate for yourself and your medical care.