Posting date: February 13, 2002

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Health Affairs, 10.1377/hlthaff.w2.96
Copyright © 2003 by Project HOPE

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Geography And The Debate Over Medicare Reform

¹ John Wennberg is director of the Center for Evaluative Clinical Science ans is the Peggy Y. Thomson Professor for Evaluative Clinical Sciences at Dartmouth Medical School in Hanover, New Hampshire.
² Elliot Fisher is codirector of the Outcomes Group, Department of Veterans Affairs Medical Center, and professor of medicine and community and family medicine at Dartmouth Medical School and the Center for the Evaluative Clinical Sciences.
³ Jonathan Skinner is the John French Professor of Economics at Dartmouth College; senior research associate at the Center for the Evaluative Clinical Sciences, Dartmouth Medical School; and a research associate at the National Bureau of Economic Research.

^*Corresponding author.

Abstract

Medicare spending varies more than twofold among regions, and the variations persist even after differences in health are corrected for. Higher levels of Medicare spending are due largely to increased use of "supply-sensitive" services-physician visits, specialist consultations, and hospitalizations, particularly for those with chronic illnesses or in their last six months of life. Also, higher spending does not result in more effective care, elevated rates of elective surgery, or better health outcomes. To improve the quality and efficiency of care, we propose a new approach to Medicare reform based on the principles of shared decision making and the promotion of centers of medical excellence. We suggest that our proposal be tested in a major demonstration project.

Key Words: Medicare, Health Reform

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