Geographic Variation


How Likely Are You to Have Heart Surgery? A C-Section? Depends Where You Live

(Getty Images)

(Getty Images)

“Location, location, location” may be a well-known maxim in real estate, but it applies in health care, too. Where you live matters in terms of what treatment you will receive for a given condition.

A new statewide survey published Tuesday found significant variation in the rate of 13 common elective procedures for several health conditions — including heart disease, childbirth and arthritis of the hip or knee. Treatments for these conditions are considered “elective” because deciding which treatment is best (or deciding on no treatment at all) can depend on someone’s preference.

It would be ideal if the patient was fully informed of all treatment options and made a decision based on his or her own preferences. But often it’s the doctor’s preferences that drive the decision. Continue reading

Where You Live Affects What Kind of Surgery You’ll Have: Look It Up

(Getty Images)

(Getty Images)

Where you live matters. And in health care, it matters in all sorts of ways you might not think of immediately. If you’re having elective surgery, one of the major factors determining what kind of treatment you will receive depends on where you live, according to new research released Tuesday.

In health policy, “elective” does not necessarily mean cosmetic surgery. Treatments for early stage cancers are considered “elective” because there are a range of options. The California Healthcare Foundation (CHCF) has been following this issue in its “All Over the Map” project. Previously, the foundation has examined variation in heart procedures, joint replacement and c-sections. Tuesday the foundation added a detailed look at geographic variation in treatments for three more conditions: breast cancer, prostate cancer, and back and neck pain.

PIcking out eyebrow-raising numbers was no problem:

  • Men in Indio (Riverside County) receive brachytherapy, known commonly as radiation seeds, to treat prostate cancer at almost five times the statewide average.
  • Women in Healdsburg (Sonoma County) receive lumpectomy without radiation for early stage breast cancer at 270 percent of the statewide average.
  • People in Brawley (Imperial County) are nearly three times as likely to receive cervical fusion, where two vertebrae in the neck are fused together, for neck problems compared to statewide.

CHCF_AllOverTheMap_Banner2_200513_R1SingleLow rates are easy to find, too. To name just one: women in Lancaster, northeast of Los Angeles, with early stage breast cancer receive lumpectomy with radiation at just 26 percent of the statewide average.

The question is why. Maribeth Shannon with the foundation says the variation is “just puzzling to us.” She stressed that the statewide average is not necessarily the “right” rate, but the state average is an estimate that’s easy to use as a benchmark.

In its analysis, the foundation accounted and adjusted for a host of patient characteristics that might skew the numbers. Still, the broad variation is there. Shannon pointed out that it would be “unusual” that patients would differ so significantly in what treatments they wanted, simply according to where they lived.

“It’s much more likely,” Shannon said, “that physicians practicing in that area tend to rely on that course of treatment over others. … It does seem to be more the physician preference than the patient preference.” Continue reading

C-Section Rates Vary – Dramatically – Across the U.S.

Researchers list four recommendations to address the variation

By Alvin Tran, Kaiser Health News

(Photo: Kaiser Health News)

(Photo: Kaiser Health News)

C-sections are the most commonly performed operation in the U.S., and a new study shows that a woman’s likelihood of having one varies ten-fold (from 7 to 70 percent) across the country.

And for women with lower-risk pregnancies? The range for them is 15-fold (from 2.4 to 36.5 percent), according to the researchers.

“We were really surprised by how much variation we saw,” said Dr. Katy Kozhimannil, an assistant professor at the University of Minnesota’s School of Public Health and the study’s lead author. Kozhimannil said she and her colleagues expected the rates of cesarean births among lower-risk mothers to vary less compared to the overall rates.

The study was published Monday in the journal Health Affairs. Continue reading

Economist Rekindles Debate over Geographic Differences in Health Spending

By Jordan Rau, Kaiser Health News

An economist at the Federal Reserve has restoked the debate over the causes of regional differences in Medicare spending, and her analysis disputes some of the thinking behind a number of policy changes in the 2010 health overhaul.

The Obama administration and many prominent economists believe that as much as a third of the $2.7 trillion spent on health care may be due to wasteful practices of physicians and hospitals that could be eliminated without hurting patients. This is based on decades of research, principally by the Dartmouth Institute for Health Policy & Clinical Practice in New Hampshire, showing that Medicare spending in some regions of the country is significantly higher than others.

This geographic variation in spending, which the government has also examined, was a motivating force behind a number of government initiatives including changes in Medicare payment to reward hospitals and doctors who provide good care efficiently. Continue reading