AHA Report Questions Beliefs About Geographic Healthcare Spending

Les Masterson, for HealthLeaders Media , November 12, 2009

The American Hospital Association released a report today that questioned studies that link geographic variation in healthcare spending to skyrocketing health costs.

The report, Geographic Variation in Health Care Spending: A Closer Look, charged that regional spending data, such as information from the Dartmouth Atlas, don't tell the full story.

"Greater exploration of the factors influencing variation is warranted before such estimates—or policies in response—can reasonably be made," according to the report.

The AHA questioned the Dartmouth Atlas' stance that higher spending does not equal higher healthcare quality. AHA wrote the Dartmouth Atlas' analysis of per-beneficiary Medicare spending across regions are often cited by policymakers, but health costs are driven by factors not addressed by the Atlas, including the number of uninsured and number of people with chronic disease.

AHA warned policymakers must be aware of the multiple reasons for a region's health costs.

"Crafting policies that hold the appropriate stakeholders accountable but avoid a one-size-fits-all strategy will be important to avoiding unintended consequences for patients and communities while improving the long-term financial stability of the U.S. healthcare system. Payment policies could address variation via payment rates, but so could public health strategies to reduce obesity or the burden of chronic conditions by targeting the underlying drivers of variation.

"Given conflicting research and local examples that contradict the hypothesized national trend, conclusions about connections between spending and quality would be premature," wrote AHA. "Understanding the value of healthcare spending for different patients and clinical scenarios is pivotal to identifying what level of spending is appropriate."

Les Masterson is an editor for HealthLeaders Media.

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