Health Affairs

Posting date: November 16, 2005

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Health Affairs, 10.1377/hlthaff.w5.526
Copyright © 2005 by Project HOPE

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Evaluating The Efficiency Of California Providers In Caring For Patients With Chronic Illnesses

John E. Wennberg ^1*, Elliott S. Fisher ², Laurence Baker ³, Sandra M. Sharp ⁴, Kristen K. Bronner ⁵

¹ John Wennberg is director of the Center for the Evaluative Clinical Sciences and the Peggy Y. Thomson Professor for the Evaluative Clinical Sciences at Dartmouth Medical School in Hanover, New Hampshire.
² Elliott Fisher is senior associate at the Veterans Affairs (VA) Outcomes Group in White River Junction, Vermont, and a professor of medicine and of community and family medicine at Dartmouth Medical School.
³ Laurence Baker is an associate professor of health services research and policy at Stanford University School of Medicine, Stanford, California.
⁴ Sandra Sharp is a research associate at Dartmouth Medical School.
⁵ Kristen Bronner is a research associate at Dartmouth Medical School.

^*Corresponding author.

Abstract

In this paper we compare the relative efficiency of health care providers in managing patients with severe chronic illnesses over fixed periods of time. To minimize the contribution of differences in severity of illness to differences in care management, we evaluate performance over fixed intervals prior to death for patients who died during a five-year period, 1999-2003. Medicare spending, hospital bed and full-time equivalent (FTE) physician inputs, and utilization varied extensively between regions, among hospitals located within a given region, and among hospitals belonging to a given hospital system. The data point to important opportunities to improve efficiency.

Key Words: Business Of Health, Chronic Care, Consumer Issues, Health Reform, Hospitals, Medicare, Physicians, State/Local Issues, Health Spending, Variations

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