Last week’s New Yorker article by Atul Gawande highlighted the phenomenally high variations in cost of medical care and services between regions in the United States, specifically focusing on McAllen, Texas. Gawande’s spotlight on McAllen was based on many studies of our health care system. For Gawande’s readers, we would like to point you to the original studies that have appeared in Health Affairs.
Discussions about the size of the medical workforce in McAllen compared to the rest of the United States appeared in a study by David Goodman, “Twenty-Year Trends in Regional Variation in the U.S. Physician Workforce,” published on the Web in October 2004.
Katherine Baicker and Amitabh Chandra have collaborated on studies of regional variations in Medicare spending and in quality outcomes since 2004 when both were at Dartmouth; they have continued this collaboration at Harvard, where they both now work. Some of their earliest work on this subject appeared in Health Affairs in April 2004: “Medicare Spending, the Physician Workforce, and Beneficiaries’ Quality of Care.” Their work also appeared in October 2004: “Who You Are and Where You Live: How Race and Geography Affect the Treatment of Medicare Beneficiaries.”
Gawande reported on a specific study conducted by Brenda Sirovich and colleagues, which looks at how primary care physicians in different regions make different and costly determinations about medical tests and diagnoses. The study appeared in Health Affairs last summer, in the May/June 2008 issue: “Discretionary Decision Making by Primary Care Physicians and the Cost of U.S. Health Care.”
Finally, the prescription recommended by Gawande, accountable care organizations, can be found in Elliott Fisher’s work in 2007: “Creating Accountable Care Organizations: The Extended Hospital Medical Staff”; and this past January: “Fostering Accountable Health Care: Moving Forward in Medicare.”
For more from Gawande, he was interviewed last night on “On Point” with Tom Ashbrook.