(Press-News.org) PITTSBURGH, Oct. 31, 2012 – Reforming Medicare payments based on large geographic regions may be too bluntly targeted to promote the best use of health care resources, a new analysis from the University of Pittsburgh Graduate School of Public Health suggests. The analysis will be published in the Nov. 1 issue of the New England Journal of Medicine.
"Much policy attention has been drawn to the large geographic variation in health care spending across regions, and for good reason – because regional variation points to inefficient use of resources," said lead author Yuting Zhang, Ph.D., associate professor of health economics at Pitt Public Health. "But it is important to effectively target these policies to reduce overutilization while maintaining access to high-quality care."
Policies that are too widely focused, such as at the larger regional level, could leave many high-spending locales untouched while inadvertently penalizing some low-spending locales. However, policies that are too finely focused, such as at the physician-level, could miss system-level factors that account for high utilization in some areas, Dr. Zhang said.
Previous geographic variation analyses primarily focused on regional areas, such as the hospital referral regions (HRRs) described in the Dartmouth Atlas of Health Care. The United States can be divided into 306 HRRs, which are areas served by large tertiary hospitals where patients are referred for major cardiovascular surgical procedures and for neurosurgery.
The HRRs can be further divided into 3,436 Dartmouth hospital-service areas (HSAs), where residents receive most of their hospital care from the hospitals in the area.
Dr. Zhang and her colleagues used enrollment, pharmacy claims and medical claims data from 2006 through 2009 from the Centers for Medicare and Medicaid Services for a 5 percent random sample of Medicare beneficiaries enrolled in stand-alone Part D plans. The study sample included about 1 million beneficiaries each year.
"We found substantial misalignment of high-spending HSAs and HRRs, after adjusting for population difference across regions," Dr. Zhang said. "Many low-spending HSAs are located within high-spending HRRs, and many high-spending HSAs are located within low-spending HRRs."
Only about half of the HSAs located within the highest-spending fifth of HRRs are themselves in the highest spending fifth of HSAs. Conversely, only about half of the highest-spending fifth of HSAs were located within the highest-spending fifth of HRRs.
For example, Manhattan was one of the HRRs with the highest drug spending in the nation, while Albuquerque was one of the lowest, after adjusting for population difference in the regions. However, the lowest-spending HSA in Manhattan had lower spending than about a quarter of the HSAs within Albuquerque.
"If a reform policy targeted the Manhattan HRR for lower Medicare payments, it would penalize low-spending local hospitals while missing the higher-spending local hospitals within the Manhattan HRR," Dr. Zhang said.
Using their analysis, Dr. Zhang and her colleagues could not determine the "right" level to target policy reforms, but suggest that focusing exclusively on the regional level is too blunt.
### The study was funded by the Institute of Medicine grant no. HHSP22320042509X, National Institute of Mental Health grant no. RC1 MH088510 and the Agency for Healthcare Research and Quality grant no. R01 HS018657.
Co-authors include Seo Hyon Baik, Ph.D., of GSPH's Department of Health Policy and Management; A. Mark Fendrick, M.D., of the University of Michigan School of Medicine; and Katherine Baicker, Ph.D., of the Harvard University School of Public Health.
About the University of Pittsburgh Graduate School of Public Health
The University of Pittsburgh Graduate School of Public Health, founded in 1948 and now one of the top-ranked schools of public health in the United States, conducts research on public health and medical care that improves the lives of millions of people around the world. Pitt Public Health is a leader in devising new methods to prevent and treat cardiovascular diseases, HIV/AIDS, cancer and other important public health problems. For more information about Pitt Public Health, visit the school's Web site at www.publichealth.pitt.edu.
http://www.upmc.com/media
Regional analysis masks substantial local variation in health care spending
2012-11-01
ELSE PRESS RELEASES FROM THIS DATE:
Tabletop fault model reveals why some quakes result in faster shaking
2012-11-01
Berkeley — The more time it takes for an earthquake fault to heal, the faster the shake it will produce when it finally ruptures, according to a new study by engineers at the University of California, Berkeley, who conducted their work using a tabletop model of a quake fault.
"The high frequency waves of an earthquake — the kind that produces the rapid jolts — are not well understood because they are more difficult to measure and more difficult to model," said study lead author Gregory McLaskey, a former UC Berkeley Ph.D. student in civil and environmental engineering. ...
Unexpected factor contributes to melanoma risk in red-haired, fair-skinned individuals
2012-11-01
The well-established elevated risk of melanoma among people with red hair and fair skin may be caused by more than just a lack of natural protection against ultraviolet (UV) radiation. In an article receiving Advance Online Publication in Nature, Massachusetts General Hospital (MGH) Cutaneous Biology Research Center (CBRC)and Cancer Center researchers report finding that the type of skin pigment predominantly found in red-haired, fair-skinned individuals may itself contribute to the development of melanoma.
"We've known for a long time that people with red hair and ...
Pond skating insects reveal water-walking secrets
2012-11-01
This month's special issue of Physics World is devoted to animal physics, and includes science writer Stephen Ornes explanation of how pond skaters effortlessly skip across water leaving nothing but a small ripple in their wake.
As Ornes writes, our current understanding of the mechanisms adopted by the pond skater is down to the efforts of David Hu, who as a mathematics graduate from the Massachusetts Institute of Technology spent four years studying their behaviour.
Hu, along with his PhD supervisor John Bush, found that pond skaters use the middle of their three ...
Sleep duration affects hunger differently in men and women
2012-11-01
A new study suggests that increasing the amount of sleep that adults get could lead to reduced food intake, but the hormonal process differs between men and women.
"Restricting sleep in healthy, normal weight participants has limited effects on metabolic risk factors and may affect food intake regulating hormones differently in men and women," said Marie-Pierre St-Onge, PhD, FAHA, the study's principal investigator. "We were surprised by the lack of a significant effect of sleep on glucose and insulin, leptin, and sex differences in the hunger-stimulating hormone ghrelin ...
Scientific team sequences 1,092 human genomes to determine standard range of human genetic variation
2012-11-01
Completing the second phase of the 1000 Genomes Project, a multinational team of scientists reports that they have sampled a total of 1092 individuals from 14 different populations and sequenced their full genomes. The researchers described the feat as a collegial effort to equip biologists and physicians with information that can be used to understand the normal range of human genetic variants so that a patient's disease genome can be interpreted in a broader context.
A report on the research, published online in Nature on Nov. 1 represents the culmination of five years ...
1,000 Genomes Project paints detailed picture of human variation
2012-11-01
HOUSTON -- (Nov. 1, 2012) – First, there was the single human reference genome completed in 2003. Then there was the HapMap project to identify the common genetic variants occurring in human beings with the first map published in 2005. Now an international consortium has released the first phase of the 1,000 Genomes Project that profiles the rare and common genetic variations in 1,092 people drawn from 14 human populations from Europe, Africa, East Asia and the Americas.
The next phase of the project will include as many as 3,000 individuals, said Dr. Fuli Yu (www.bcm.edu/genetics/index.cfm?pmid=23673
), ...
New genetic links for inflammatory bowel disease uncovered
2012-11-01
Crohn's disease (CD) and ulcerative colitis (UC) – inflammatory diseases of the gastrointestinal tract – have puzzled the scientific community for decades. Ten years ago, researchers recognized that both genes and the environment contributed to these diseases but knew little about precisely how and why illness occurred. To begin to narrow in on the key pathways involved, they would need thousands of patients' samples, millions of data points, and the commitment of physicians and scientists at dozens of institutions.
Today, researchers from across the CD and UC communities ...
Fear of math can hurt
2012-11-01
Fear of math can activate regions of the brain linked with the experience of physical pain and visceral threat detection, according to research published Oct 31 by Ian Lyons and colleagues at the University of Chicago in the open access journal PLOS ONE.
The researchers found that in individuals who experience high levels of anxiety when facing math tasks, the anticipation of math increases activity in regions of the brain associated with the physical sensation of pain. The higher an individual's math anxiety, the more such neural activity was increased.
According ...
5 year olds are generous only when they're watched
2012-11-01
Children as young as five are generous when others are aware of their actions, but antisocial when sharing with a recipient who can't see them, according to research published Oct. 31 in the open access journal PLOS ONE by Kristin Lyn Leimgruber and colleagues from Yale University.
Adults are more likely to behave in ways that enhance their reputation when they are being watched or their actions are likely to be made public than when they are anonymous, but this study examines the origins of such behavior in young children for the first time. For their study, the researchers ...
Desert farming forms bacterial communities that promote drought resistance
2012-11-01
When there is little water available for plants to grow, their roots form alliances with soil microbes that can promote plant growth even under water-limiting conditions, according to research published Oct. 31 by Daniele Daffonchio and colleagues from the University of Milan, Italy in the open access journal PLOS ONE.
Symbiotic relationships between plants and soil microbial communities are critical to the health of plants. Though the effects of drought on plants are well-known, little is known about how lack of water affects the bacteria around plant roots.
In this ...