HANOVER, NH/WHITE RIVER JUNCTION, VT Physicians practicing in regions of the U.S. where health care spending is high are more likely to order tests, referrals and treatments for their patients than those in low spending regions, according to researchers at the VA Outcomes Group (White River Junction, Vermont) and Dartmouth Medical School (DMS). As new data emerges that health care spending has little relationship to health outcomes, these findings point to one reason behind the dramatic variation in the cost of health care across different regions in the U.S.

It is widely recognized that health care spending varies noticeably across the United States averaging less than $5000 per year for each Medicare beneficiary in Portland, Oregon, and over $10,000 in Miami, Florida. "What hasn't been clear," said the study's primary author, Dr. Brenda Sirovich, Staff Physician at the White River Junction VA Medical Center and assistant professor of medicine at DMS, "is whether spending is so different across various areas because the patients are different in other words, more or less sick or because the doctors are different. We did this study to find out whether it is in fact differences in doctors, and the decisions they make, that contribute to the large differences in spending that we see."

The study, appearing in the October 24 issue of Archives of Internal Medicine, measured the responses of 5490 primary care physicians to a survey in which they were presented with clinical scenarios and asked how often they would order a specific test, referral, or treatment for each patient described. Sirovich and colleagues used Medicare data to characterize spending in the region where each physician practiced, a figure that ranged from an average of $4911 per capita in the areas of lowest spending to $8325 in the highest spending areas.

The authors found that physicians who practice in areas of high spending do more they order more tests, referrals
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Contact: Andy Nordhoff
andy.nordhoff@dartmouth.edu
603-650-1492
Dartmouth Medical School
24-Oct-2005

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