Wide Disparity Found in Medical Treatments
Doctors perform some medical treatments 10 to 20 times more often in certain parts of the country than in others--but it is unclear whether those doctors are wasting money on unneeded procedures or whether their counterparts elsewhere are providing too little care, according to a group of California researchers.
When the reasons for the disparities are determined--something the researchers hope to do within the next nine months--the answers are likely to have enormous implications for government health planners and insurers who are trying to set appropriate care rates.
Writing in today’s New England Journal of Medicine, the researchers, most of whom are affiliated with Rand Corp. and UCLA, say they found “large and significant differences in the use of services provided by all medical and surgical specialties.” While there was less than a threefold difference in mastectomies and appendectomies, there was an elevenfold difference in hip replacement operations and a twenty-sixfold difference in one treatment for hemorrhoids.
Major differences also appeared in the frequency of repair of arm fractures, coronary bypass operations, surgical removal of non-cancerous skin diseases and other common treatments. By contrast, there was little difference in cataract surgery and prostate operations. Of 123 medical procedures that the researchers studied, 67 showed at least a threefold difference between geographical areas.
The study, which supports the conclusions of earlier but less extensive studies, is based on 1981 data of 340,000 65-year-old Medicare beneficiaries in 13 major metropolitan areas, ranging from Northern California to South Carolina.
The researchers have yet to release any data on which parts of the country had higher rates than others because, they said, they fear such information would be used inappropriately by government health planners eager to cut health costs.
Health planners often assume that “less is best” and that is not necessarily the case, said Dr. Robert H. Brook, one of the senior researchers on the project. “While it is true that some procedures may be overused in certain areas, other procedures may simply not be available to patients who need them.”
Over the next six to nine months, Brook said, his nine-person research group will analyze the use of specific procedures to determine what level of medical care is appropriate.
