Americans have every reason to dislike Ryan’s plan. Starting in 2022, it would give Medicare beneficiaries an $8,000 voucher — the amount currently spent on the average recipient — to go out and buy health insurance on the private market. Eight thousand dollars won’t buy much health insurance in many markets, and seniors who can’t make up the difference would be left with little or no coverage.

However, there is one good thing about Ryan’s plan, and it has been completely overlooked. Offering beneficiaries the same voucher, no matter where they live, would expose the egregious amount of money Medicare wastes in many parts of the country.

In Minneapolis, Medicare spent on average about $7,000 per beneficiary in 2007, the most recent Dartmouth Atlas figure available. That’s on the low end. Medicare spent about the same amount in Sacramento, Calif., and Salt Lake City, and even less in Salem, Ore. At the high end, Medicare paid out nearly $16,000 per beneficiary in .聽Spending in Miami, Detroit and Boston wasn’t far behind.

What could possibly account for a $9,000 difference in spending? It isn’t prices, since Medicare does a good job of controlling prices across the country. If you ask hospitals and physicians in these high spending regions, they will say their patients are sicker and need more care. That claim just isn’t borne out by the data. Poverty and chronic disease are the main reasons patients need more care. There’s a two-and-a-half fold difference in spending between the highest- and lowest-spending regions, but the prevalence of chronic disease or poverty in these regions explains only a fraction of the variation.

And it doesn’t look as if Medicare recipients in these high-spending areas are getting better care, or more effective care. They are simply getting a lot of extra care they do not need — and Medicare foots the bill.

Under the current system, beneficiaries are largely shielded from both regional differences in spending and from the way their health care is delivered. Medicare picks up the tab for 80 percent of the cost of care, and most patients don’t know the difference between necessary and unnecessary care. Under the Ryan plan, those regional differences might come into focus when seniors are forced to buy their insurance on the private market.

There’s no guarantee that private insurers would base their prices on local spending, but if they did, $8,000 a year would buy patients in Minneapolis a gold-plated health plan, with all sorts of fringe benefits — maybe a new pair of glasses every year, or memberships in health clubs. In Miami and McAllen, $8,000 would hardly be enough for a high-deductible plan.

There are a couple of scenarios that might result from making such disparities transparent. Medicare beneficiaries in McAllen and Miami would complain to their members of Congress, who would lean on Medicare to offer bigger vouchers to beneficiaries in high-spending regions. Of course, this would defeat the purpose of the Ryan plan and leave Medicare shelling out just as much as it does now, when it’s still an entitlement.

But if Congress stuck to its guns, and if insurers did price their plans on the basis of current spending patterns, Medicare patients in high spending regions would either have to dig into their pockets for the difference between their voucher and local premium prices, or they would have to move from more expensive to more affordable regions as they get priced out of the health care market. A senior citizen in McAllen might choose to move to nearby San Antonio, where average per beneficiary costs are just north of $9,000. Of course, that may not be an option for the oldest and sickest patients. Many elderly patients will be unable to be selective about where they receive their medical care, and if the healthiest patients move to less expensive regions, premiums in the already-expensive regions could spiral out of control.

There is a third alternative. Providers in the high-spending regions could learn to care for patients more conservatively. Much of the can be attributed to disorganization among providers in high-spending regions, and their habit of delivering exceptionally aggressive care at the end of life. These regions generally have a high number of specialists per capita, and a high ratio of specialists to primary care providers. Greed is also part of the problem. The amount of fraud makes south Florida look a little like the intersection between medicine and the “Pirates of the Caribbean.”

Getting providers in high-spending regions to modify the way they deliver care and to look more like providers in low-spending regions is the goal of much of the health law, and turning Medicare into a defined contribution could bring the problem of regional variation into focus. But it’s hardly the ideal way to drive reform of health care delivery. That should be accomplished with a reimbursement system that makes the provider, not just the patient, vulnerable to the economic consequences of excessive Medicare spending.

Shannon Brownlee is the acting director of the New America Foundation Health Policy Program. Eric Schultz was a New America health policy intern.

This <a target="_blank" href="/medicare/060611brownleeschultz/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

While the death of a child is always a tragedy, is the panic justified? Let’s look at the statistics.

First up, while it’s happening earlier, is the 2009 H1N1 more dangerous than garden variety seasonal flu, for healthy kids compared to kids with underlying illnesses? According to a paper published last month in the New England Journal of Medicine, probably not. The authors found that 60 percent of children who were hospitalized with swine flu had underlying illnesses.聽In years past, only 31 to 43 percent of children聽who were聽hospitalized with seasonal flu had similar underlying illnesses 耸 meaning that the rate at which 2009 H1N1 causes serious illness in healthy children is lower than with seasonal flu.

We found much the same picture when we looked at the actual reports of the first 36 pediatric flu deaths this year from around the country posted by the Centers for Disease Control and Prevention (CDC). The majority of those children (70 percent) had multiple, severe underlying conditions, such as congenital heart and lung disease, for instance, or cerebral palsy. And that’s not counting morbid obesity, which many flu experts believe should be considered a risk factor.

Certainly it appears as if there have been proportionately more deaths among young people than the elderly compared with seasonal flu years, but that’s largely because fewer old people are dying than usual. They may have some residual immunity from being exposed to related viruses in the past, but whatever the reason, the proportion of deaths among younger people is automatically larger this year.

According to the CDC’s most recent update, there have been 156 2009 H1N1 flu deaths in the U.S. among children and teens 17 years old and younger. Last week, the CDC extrapolated from those numbers to estimate about 540 pediatric deaths. (The estimate is derived by taking the number of laboratory-confirmed flu deaths and running it through a complicated formula and computer model.)

It sounds like a lot of kids dying, but we don’t really know how the death rate compares to previous years. During last year’s regular flu season, for example, there were 115 laboratory confirmed flu deaths reported among this same age group.

An additional complicating factor: It turns out that the number of reported pediatric flu deaths has been steadily rising each year since 2005 (and possibly earlier). During the 2005-2006 flu season, 46 pediatric lab-confirmed deaths were reported. In 2006-2007 the number rose to 78. By 2007-2008, there were 88 deaths, followed by 115 last year.

Although the number of this year’s deaths will probably rise in coming months, it’s important to compare apples to apples. To date, the number of laboratory-confirmed pediatric deaths is only marginally greater than last year’s 耸 and a disproportionate number of those children have underlying illnesses.

No one knows for sure why flu deaths among children are going up, but the CDC told us that doctors are probably “doing a better job of reporting.” Better book-keeping, in other words, not more virulent viruses, is responsible for at least part of the apparent increase in pediatric deaths in recent years. Based on this trend alone, we would expect that the number of pediatric deaths would be higher this year than last.

What’s more, additional changes in book-keeping may exaggerate the total number of swine flu deaths reported among all age groups. This year, the CDC liberalized the definition of what it counts as a flu death for people over age 18. Until now, only deaths in which the patient had laboratory-confirmed influenza were used to estimate the annual mortality statistics for seasonal flu, which the CDC says causes about 36,000 deaths a year in the U.S., according to their mathematical modeling projections.

As of August 31, however, the CDC said that anyone 18 years or older who dies with a syndrome known as influenza-like illness, or ILI, can be included in the count. The CDC has no requirement for uniform reporting of flu deaths by the states. Twenty-eight states, according to the agency, report only laboratory-confirmed flu deaths, while the others are now reporting deaths that look to doctors like they might be the result of flu.

That decision could dramatically inflate the numbers of reported flu deaths this year. By the CDC’s weekly聽 when doctors think a patient has the flu, they are wrong between 46 and 82 percent of the time. This isn’t a criticism of doctors; it is virtually impossible to distinguish flu from illnesses caused by germs like coronavirus and many others. However, it does mean that once the CDC extrapolates its estimates for the entire population, swine flu mortality could appear to be as much as an order of magnitude greater than seasonal flu, whether or not there is any real increase in deaths.

Why should any of this matter? In part, because statistics, when filtered by the popular media, can scare the daylights out of the public and feed worries that may not be justified. The numbers also matter to public policy. As reported deaths rise, the CDC tends to enlarge its recommendation for who should be vaccinated, and who should receive anti-viral drugs. For example, based on rising pediatric deaths, the CDC issued new recommendations in 2009 that all children from 6 months to 18 years should get the flu vaccine each year. Previously, the vaccine was recommended only for high-risk children.

That’s not to say that we all shouldn’t exercise caution this flu season, or that the U.S. government is deliberately fanning fear by changing its definition of what counts as a flu death. But at a time when we are worrying about rising health care costs, there’s an argument for basing multi-billion-dollar investments in vaccine campaigns and stockpiling antiviral drugs on solid numbers.

This <a target="_blank" href="/news/111709brownleelenzer/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Many researchers and providers agree with this assessment, and I’ve had individual physicians tell me that they know for a fact that patients are being put at risk in their hospitals by all the unnecessary care they receive. So why are a handful of administrators and doctors at some of the nation’s most prestigious academic medical centers trying to discredit Dartmouth’s findings? The answer, in a word, is money.

Using Medicare claims data, the Dartmouth Atlas shows that different hospitals deliver wildly differing amounts of care to patients with similar conditions and similar levels of illness. In two seminal papers published in 2003, Dartmouth’s Elliott Fisher showed that patients who had suffered a hip fracture, heart attack, or had colon cancer that needed surgery, got very different care, depending upon where they lived. For example, a heart attack patient who lives in, say, Los Angeles, will receive about $7,000-worth of extra care over the course of a year than a similar patient in Salem, Oregon. That $7,000 of extra Medicare spending in LA wasn’t due to higher prices, it went towards more services 耸 more hospitalizations, more drugs, doctor visits, tests, and procedures.

Nobody disputes these variations in spending or utilization. The part that makes doctors and administrators in places like LA see red is Dartmouth’s conclusion that all that extra care doesn’t necessarily result in better outcomes. It’s mostly waste.

They worry that the Centers for Medicare and Medicaid Services (CMS) will use Dartmouth data as a benchmark for measuring health care efficiency and try to wring savings out of the most inefficient regions — Los Angeles, for instance, down-state New York, all of New Jersey, Miami and McAllen, Texas (which was profiled as the most expensive town in America for health care in a article). The Baucus health care reform bill would create and fund an “innovation center” within CMS, with broad powers to experiment with different payment options aimed at “bending the curve,” reining in the rate of growth of health care spending. According to Fisher, 20 to 30 percent of inpatient hospital days and 30 to 40 percent of specialist visits could be eliminated in the most inefficient hospitals without hurting patient outcomes.

To do that, CMS could employ a range of incentives such as a shared savings program, which would reward administrators for emulating more efficient hospitals 耸 places like Intermountain Healthcare, in Utah, and the Geisinger Clinic of Pennsylvania, which were recently by President Obama as medical exemplars. Another way to control costs and encourage better care would be to spare providers in more efficient regions from across the board cuts in Medicare payments.聽聽

Rather than stepping up to the plate and vowing to get to the bottom of their spending problem, some academic medical centers are instead attacking the Dartmouth findings. They explain away the data by saying their patients are poorer and sicker, and therefore need more care. In Los Angeles, for example, where 15 percent of the population is below the poverty line, the average Medicare recipient costs the federal government $10,810, compared with $6,705 per recipient in Minneapolis, where 10 percent of citizens are below the poverty line.聽

This claim, that poverty and illness lie at the heart of variation in Medicare spending, 聽makes intuitive sense, but it doesn’t hold up to careful . Poverty does influence health, but it can’t account for the extraordinary differences in the volume of care delivered by academic medical centers 耸 even when they are located within a few miles of one another. In Manhattan, for example, chronically ill Medicare recipients, whether they are poor or not, are given about 40 percent more services at New York University Medical Center than nearby Columbia Presbyterian. In Chicago, African-American Medicare patients suffering from chronic illness, who are generally poorer than white beneficiaries, spent 46 percent more days in the hospital at Rush-Presbyterian than African-American beneficiaries using the University of Chicago. There’s no evidence that patients at Rush-Presbyterian and NYU are enjoying better outcomes.

Academic medical centers are supposed to lead medicine toward better, more effective care. They are typically considered centers of excellence, beacons of sound medical science. Trying to discredit the Dartmouth data is a distraction from the real work that’s needed to understand and remedy the extraordinary amount of money spent on care that does not appear to make a difference in health.

Shannon Brownlee is a Senior Research Fellow at the New America Foundation and author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.

This <a target="_blank" href="/health-industry/102209brownlee/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Americans have every reason to dislike Ryan’s plan. Starting in 2022, it would give Medicare beneficiaries an $8,000 voucher — the amount currently spent on the average recipient — to go out and buy health insurance on the private market. Eight thousand dollars won’t buy much health insurance in many markets, and seniors who can’t make up the difference would be left with little or no coverage.

However, there is one good thing about Ryan’s plan, and it has been completely overlooked. Offering beneficiaries the same voucher, no matter where they live, would expose the egregious amount of money Medicare wastes in many parts of the country.

In Minneapolis, Medicare spent on average about $7,000 per beneficiary in 2007, the most recent Dartmouth Atlas figure available. That’s on the low end. Medicare spent about the same amount in Sacramento, Calif., and Salt Lake City, and even less in Salem, Ore. At the high end, Medicare paid out nearly $16,000 per beneficiary in .聽Spending in Miami, Detroit and Boston wasn’t far behind.

What could possibly account for a $9,000 difference in spending? It isn’t prices, since Medicare does a good job of controlling prices across the country. If you ask hospitals and physicians in these high spending regions, they will say their patients are sicker and need more care. That claim just isn’t borne out by the data. Poverty and chronic disease are the main reasons patients need more care. There’s a two-and-a-half fold difference in spending between the highest- and lowest-spending regions, but the prevalence of chronic disease or poverty in these regions explains only a fraction of the variation.

And it doesn’t look as if Medicare recipients in these high-spending areas are getting better care, or more effective care. They are simply getting a lot of extra care they do not need — and Medicare foots the bill.

Under the current system, beneficiaries are largely shielded from both regional differences in spending and from the way their health care is delivered. Medicare picks up the tab for 80 percent of the cost of care, and most patients don’t know the difference between necessary and unnecessary care. Under the Ryan plan, those regional differences might come into focus when seniors are forced to buy their insurance on the private market.

There’s no guarantee that private insurers would base their prices on local spending, but if they did, $8,000 a year would buy patients in Minneapolis a gold-plated health plan, with all sorts of fringe benefits — maybe a new pair of glasses every year, or memberships in health clubs. In Miami and McAllen, $8,000 would hardly be enough for a high-deductible plan.

There are a couple of scenarios that might result from making such disparities transparent. Medicare beneficiaries in McAllen and Miami would complain to their members of Congress, who would lean on Medicare to offer bigger vouchers to beneficiaries in high-spending regions. Of course, this would defeat the purpose of the Ryan plan and leave Medicare shelling out just as much as it does now, when it’s still an entitlement.

But if Congress stuck to its guns, and if insurers did price their plans on the basis of current spending patterns, Medicare patients in high spending regions would either have to dig into their pockets for the difference between their voucher and local premium prices, or they would have to move from more expensive to more affordable regions as they get priced out of the health care market. A senior citizen in McAllen might choose to move to nearby San Antonio, where average per beneficiary costs are just north of $9,000. Of course, that may not be an option for the oldest and sickest patients. Many elderly patients will be unable to be selective about where they receive their medical care, and if the healthiest patients move to less expensive regions, premiums in the already-expensive regions could spiral out of control.

There is a third alternative. Providers in the high-spending regions could learn to care for patients more conservatively. Much of the can be attributed to disorganization among providers in high-spending regions, and their habit of delivering exceptionally aggressive care at the end of life. These regions generally have a high number of specialists per capita, and a high ratio of specialists to primary care providers. Greed is also part of the problem. The amount of fraud makes south Florida look a little like the intersection between medicine and the “Pirates of the Caribbean.”

Getting providers in high-spending regions to modify the way they deliver care and to look more like providers in low-spending regions is the goal of much of the health law, and turning Medicare into a defined contribution could bring the problem of regional variation into focus. But it’s hardly the ideal way to drive reform of health care delivery. That should be accomplished with a reimbursement system that makes the provider, not just the patient, vulnerable to the economic consequences of excessive Medicare spending.

Shannon Brownlee is the acting director of the New America Foundation Health Policy Program. Eric Schultz was a New America health policy intern.

This <a target="_blank" href="/medicare/060611brownleeschultz/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

While the death of a child is always a tragedy, is the panic justified? Let’s look at the statistics.

First up, while it’s happening earlier, is the 2009 H1N1 more dangerous than garden variety seasonal flu, for healthy kids compared to kids with underlying illnesses? According to a paper published last month in the New England Journal of Medicine, probably not. The authors found that 60 percent of children who were hospitalized with swine flu had underlying illnesses.聽In years past, only 31 to 43 percent of children聽who were聽hospitalized with seasonal flu had similar underlying illnesses 耸 meaning that the rate at which 2009 H1N1 causes serious illness in healthy children is lower than with seasonal flu.

We found much the same picture when we looked at the actual reports of the first 36 pediatric flu deaths this year from around the country posted by the Centers for Disease Control and Prevention (CDC). The majority of those children (70 percent) had multiple, severe underlying conditions, such as congenital heart and lung disease, for instance, or cerebral palsy. And that’s not counting morbid obesity, which many flu experts believe should be considered a risk factor.

Certainly it appears as if there have been proportionately more deaths among young people than the elderly compared with seasonal flu years, but that’s largely because fewer old people are dying than usual. They may have some residual immunity from being exposed to related viruses in the past, but whatever the reason, the proportion of deaths among younger people is automatically larger this year.

According to the CDC’s most recent update, there have been 156 2009 H1N1 flu deaths in the U.S. among children and teens 17 years old and younger. Last week, the CDC extrapolated from those numbers to estimate about 540 pediatric deaths. (The estimate is derived by taking the number of laboratory-confirmed flu deaths and running it through a complicated formula and computer model.)

It sounds like a lot of kids dying, but we don’t really know how the death rate compares to previous years. During last year’s regular flu season, for example, there were 115 laboratory confirmed flu deaths reported among this same age group.

An additional complicating factor: It turns out that the number of reported pediatric flu deaths has been steadily rising each year since 2005 (and possibly earlier). During the 2005-2006 flu season, 46 pediatric lab-confirmed deaths were reported. In 2006-2007 the number rose to 78. By 2007-2008, there were 88 deaths, followed by 115 last year.

Although the number of this year’s deaths will probably rise in coming months, it’s important to compare apples to apples. To date, the number of laboratory-confirmed pediatric deaths is only marginally greater than last year’s 耸 and a disproportionate number of those children have underlying illnesses.

No one knows for sure why flu deaths among children are going up, but the CDC told us that doctors are probably “doing a better job of reporting.” Better book-keeping, in other words, not more virulent viruses, is responsible for at least part of the apparent increase in pediatric deaths in recent years. Based on this trend alone, we would expect that the number of pediatric deaths would be higher this year than last.

What’s more, additional changes in book-keeping may exaggerate the total number of swine flu deaths reported among all age groups. This year, the CDC liberalized the definition of what it counts as a flu death for people over age 18. Until now, only deaths in which the patient had laboratory-confirmed influenza were used to estimate the annual mortality statistics for seasonal flu, which the CDC says causes about 36,000 deaths a year in the U.S., according to their mathematical modeling projections.

As of August 31, however, the CDC said that anyone 18 years or older who dies with a syndrome known as influenza-like illness, or ILI, can be included in the count. The CDC has no requirement for uniform reporting of flu deaths by the states. Twenty-eight states, according to the agency, report only laboratory-confirmed flu deaths, while the others are now reporting deaths that look to doctors like they might be the result of flu.

That decision could dramatically inflate the numbers of reported flu deaths this year. By the CDC’s weekly聽 when doctors think a patient has the flu, they are wrong between 46 and 82 percent of the time. This isn’t a criticism of doctors; it is virtually impossible to distinguish flu from illnesses caused by germs like coronavirus and many others. However, it does mean that once the CDC extrapolates its estimates for the entire population, swine flu mortality could appear to be as much as an order of magnitude greater than seasonal flu, whether or not there is any real increase in deaths.

Why should any of this matter? In part, because statistics, when filtered by the popular media, can scare the daylights out of the public and feed worries that may not be justified. The numbers also matter to public policy. As reported deaths rise, the CDC tends to enlarge its recommendation for who should be vaccinated, and who should receive anti-viral drugs. For example, based on rising pediatric deaths, the CDC issued new recommendations in 2009 that all children from 6 months to 18 years should get the flu vaccine each year. Previously, the vaccine was recommended only for high-risk children.

That’s not to say that we all shouldn’t exercise caution this flu season, or that the U.S. government is deliberately fanning fear by changing its definition of what counts as a flu death. But at a time when we are worrying about rising health care costs, there’s an argument for basing multi-billion-dollar investments in vaccine campaigns and stockpiling antiviral drugs on solid numbers.

This <a target="_blank" href="/news/111709brownleelenzer/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Many researchers and providers agree with this assessment, and I’ve had individual physicians tell me that they know for a fact that patients are being put at risk in their hospitals by all the unnecessary care they receive. So why are a handful of administrators and doctors at some of the nation’s most prestigious academic medical centers trying to discredit Dartmouth’s findings? The answer, in a word, is money.

Using Medicare claims data, the Dartmouth Atlas shows that different hospitals deliver wildly differing amounts of care to patients with similar conditions and similar levels of illness. In two seminal papers published in 2003, Dartmouth’s Elliott Fisher showed that patients who had suffered a hip fracture, heart attack, or had colon cancer that needed surgery, got very different care, depending upon where they lived. For example, a heart attack patient who lives in, say, Los Angeles, will receive about $7,000-worth of extra care over the course of a year than a similar patient in Salem, Oregon. That $7,000 of extra Medicare spending in LA wasn’t due to higher prices, it went towards more services 耸 more hospitalizations, more drugs, doctor visits, tests, and procedures.

Nobody disputes these variations in spending or utilization. The part that makes doctors and administrators in places like LA see red is Dartmouth’s conclusion that all that extra care doesn’t necessarily result in better outcomes. It’s mostly waste.

They worry that the Centers for Medicare and Medicaid Services (CMS) will use Dartmouth data as a benchmark for measuring health care efficiency and try to wring savings out of the most inefficient regions — Los Angeles, for instance, down-state New York, all of New Jersey, Miami and McAllen, Texas (which was profiled as the most expensive town in America for health care in a article). The Baucus health care reform bill would create and fund an “innovation center” within CMS, with broad powers to experiment with different payment options aimed at “bending the curve,” reining in the rate of growth of health care spending. According to Fisher, 20 to 30 percent of inpatient hospital days and 30 to 40 percent of specialist visits could be eliminated in the most inefficient hospitals without hurting patient outcomes.

To do that, CMS could employ a range of incentives such as a shared savings program, which would reward administrators for emulating more efficient hospitals 耸 places like Intermountain Healthcare, in Utah, and the Geisinger Clinic of Pennsylvania, which were recently by President Obama as medical exemplars. Another way to control costs and encourage better care would be to spare providers in more efficient regions from across the board cuts in Medicare payments.聽聽

Rather than stepping up to the plate and vowing to get to the bottom of their spending problem, some academic medical centers are instead attacking the Dartmouth findings. They explain away the data by saying their patients are poorer and sicker, and therefore need more care. In Los Angeles, for example, where 15 percent of the population is below the poverty line, the average Medicare recipient costs the federal government $10,810, compared with $6,705 per recipient in Minneapolis, where 10 percent of citizens are below the poverty line.聽

This claim, that poverty and illness lie at the heart of variation in Medicare spending, 聽makes intuitive sense, but it doesn’t hold up to careful . Poverty does influence health, but it can’t account for the extraordinary differences in the volume of care delivered by academic medical centers 耸 even when they are located within a few miles of one another. In Manhattan, for example, chronically ill Medicare recipients, whether they are poor or not, are given about 40 percent more services at New York University Medical Center than nearby Columbia Presbyterian. In Chicago, African-American Medicare patients suffering from chronic illness, who are generally poorer than white beneficiaries, spent 46 percent more days in the hospital at Rush-Presbyterian than African-American beneficiaries using the University of Chicago. There’s no evidence that patients at Rush-Presbyterian and NYU are enjoying better outcomes.

Academic medical centers are supposed to lead medicine toward better, more effective care. They are typically considered centers of excellence, beacons of sound medical science. Trying to discredit the Dartmouth data is a distraction from the real work that’s needed to understand and remedy the extraordinary amount of money spent on care that does not appear to make a difference in health.

Shannon Brownlee is a Senior Research Fellow at the New America Foundation and author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.

This <a target="_blank" href="/health-industry/102209brownlee/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">