Geographic Variation in Cost of Health Care Not Linked to Inappropriate Care

A literature review published in Medical Care questions the notion that US regions spending more on health care and having higher rates of use deliver more unnecessary care to patients and that areas spending less provide more efficient and higher quality care.

Salomeh Keyhani, MD, MPH, and colleagues performed a Medline search to analyze 114,830 articles published between January 1, 1978 — the first year a framework for quality appeared in the literature — and January 1, 2009. They found five papers that compared geographical variations of health care to the overuse of health care services, according to the study abstract. However, the results of those studies were insufficient to conclude that geographical areas with higher health care costs deliver inappropriate care.

“The literature is so limited that you cannot either support or refute such an assertion. There is just not enough data,” Keyhani, an assistant professor of medicine at the University of California and physician at the San Francisco Veterans Affairs Medical Center, stated in a press release from the University of California, San Francisco.

 “Geographical variations in health care have captured the attention of researchers for the past 30 years, especially during the recent health care reform debate,” she stated in the release. “The assumption is that areas that spend more are delivering more inappropriate care in the form of unnecessary tests and procedures. This has led policy makers to hold up low-cost areas as models of high-quality health care and to propose policies that cap spending.”

A lack of patient care guidelines plays a major factor, according to Keyhani. Guidelines will tell physicians when to perform a test, but do not indicate when a test might be inappropriate or unnecessary. This impacts expenses and patient care. A nationwide effort to create guidelines to address these problems is needed, she said.

“People assume that more care is better. In fact, we know that unwarranted procedures can add to health risks and lead to poor outcomes,” Keyhani said.

For more information:

Keyhani S, Falk R, Bishop T, et al. The relationship between geographic variations and overuse of health care services: a systematic review. Med Care. 2012;50(3):257-261. doi:10.1097/MLR.0b013e3182422b0f


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