There appear to be differences in the way that medicine is provided across region. This project addresses the consequences of regional differences in health care intensity for health, functioning, and well-being more generally. Knowing the answer to these questions is important, because it will allow us to judge whether elderly Americans in high expenditure regions value the additional care they are receiving. In particular, the goals of this project are to 1. Study the impact of variations in health care intensity on survival by carrying out longitudinal cohort studies of three chronic disease cohorts, i.e., myocardial infarction, hip fracture and colon cancer. 2. Examine the impact of variations in intensity on function, well-being and disease-specific quality of life using longitudinal cohort studies in three groups sampled from the Medicare population: the Medicare Current Beneficiary Survey (MCBS), for whom we have measures of self-assessed health and physical function, the proposed Core Survey, for whom we have measures of well-being in physical well-being and mental well being, and men in regions that were early and later adopters of a more intensive approach to the detection and treatment of prostate cancer. 3. Explore how intensity is valued in different regions. We will use data from the Core Telephone Survey to determine patient preferences for specific treatments and determine the degree to which high or low intensity regions improve the health and functioning of patients with different preferences. We will use in-person interviews in three regions (Florida, Oregon, and Sun City, Arizona) to determine how Medicare enrollees in these communities value major dimensions of intensity and whether those values reflect community treatment patterns.
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