Digging Into the Dartmouth Atlas

In case you’re not familiar with it, the Dartmouth Atlas of Health Care is a decades long project started by Dr. John Wennberg to explore small area (i.e., regional) variation in health care utilization, spending, and the like. You can find out more about them here. They’re the folks behind a lot of studies that you might have read about in the popular press, with the basic premise that there’s a wide range of variation in utilization and spending that isn’t easily explained.

In a recent article, Daniel Gottlieb and colleagues find that these regional differences in spending are primarily affected not–as many people thought–by differences in prices, but rather by differences in utilization rates. One has to assume that those differences in utilization are driven by the intersection of different patient populations and different physician practice patterns, but how much of the difference is justified and how much is wasteful has yet to be quantified.

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