Patients in high-cost regions have access to the same technology as those in low-cost regions, and those in low-cost regions are not deprived of needed care. On the contrary, the researchers note that care is often better in low-cost areas. The authors argue that the differences in growth are largely due to discretionary decisions by physicians that are influenced by the local availability of hospital beds, imaging centers and other resources-and a payment system that rewards growth and higher utilization.
Virginians can take some pride in the fact that the Old Dominion is one of the lowest-cost pockets of health care in the eastern U.S. Take a look at the map above: Wisconsin and upstate New York are the only comparable zones of low health care costs east of the Mississippi. (To see how individual Hospital Referral Regions in Virginia perform compared to others in the nation, view the interactive map.) The cost of Medicare per enrollee is less than $7,000 across most of the state. Even in the Arlington region, with its high wage and salary levels, the cost edges up to $7,200 — far lower than the cost up a few miles north in Baltimore.
Clearly, Virginia hospitals and physicians are doing something right. And just as clearly, Virginians should not be made to suffer for the sins of health care delivery in other states.
The Dartmouth Atlas supports the claims of those who contend that much of American health care spending is wasted. How do we reform the system to bring down soaring costs? “An Agenda for Change” proposes the following:
- Promote the growth of organized systems of care.
- Require informed patient choice and informed decision making.
- Promote the training of primary care physicians and fund training programs that teach community-based care in treating chronic illness.
- Fund a federal science policy that builds the scientific basis for cost-effective care.
The Dartmouth Institute bases its recommendations on hard empirical data, not ideology. I’m not persuaded that the atlas afficianados have the full answer, but they have a very big piece of the answer. I only wish that someone in Washington were listening.