In 1996, average Medicare per capita expenditures were $3,700 in Minneapolis and $7,783 in Miami. Differences of a similar magnitude were observed across regions in patterns of end-of-life care, such as the chances of dying in a hospital or the number of different specialists seen in the last 6 months of life. Previous research indicates that these geographic variations in treatment are due largely to differences in intensity, i.e., differences in the way similar patients are treated. Improved understanding of the causes and consequences of regional variations in intensity could have important implications for the health and well-being of the elderly, for addressing health disparities and for the financial health of the Medicare trust funds. This project addresses these issues by: 1. Measuring how patients of similar illness levels are treated differently across regions with respect to both overall intensity and different dimensions of intensity. 2. Determining the causes of differences in intensity. To what extent are they due to patient preferences for care, physician beliefs, or other factors? Why is it the norm in some regions but not others for elderly patients to experience extensive diagnostic testing for CAD, with subsequent downstream procedures, specialist referrals, and hospitalization? 3. Studying the consequences of greater health care intensity. What is the impact of greater intensity of care on outcomes that include survival, health functioning, and well-being more generally? 4. Seeking to understand how health care intensity, either across regions or over time, affects disparities across socioeconomic groups in health care treatments and outcomes. The project will bring together a cross-disciplinary research team comprised of investigators from the DAWG; the PORT; the Maine Medical Center; the Center for Survey Research in Boston, MA; Massachusetts General Hospital; and the National Bureau of Economic Research.
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