Variations in the Use of Medical and Surgical Services by the Medicare Population

TLDR

The study highlights uncertainty about whether high‑ or low‑use areas reflect over‑ or under‑procedure practices by physicians. The authors measured geographic variation in Medicare medical and surgical service use in 13 large U.S. regions during 1981. Large, significant geographic differences were observed across all specialties, with 67 of 123 procedures exhibiting at least threefold variation between sites, and the patterns of use suggesting coordinated diagnostic and treatment practices rather than isolated physician behavior, indicating that these disparities are too large to ignore.

Abstract

Abstract We measured geographic differences in the use of medical and surgical services during 1981 by Medicare beneficiaries (age ≥65) in 13 large areas of the United States. The average number of Medicare beneficiaries per site was 340,000. We found large and significant differences in the use of services provided by all medical and surgical specialties. Of 123 procedures studied, 67 showed at least threefold differences between sites with the highest and lowest rates of use. Use rates were not consistently high in one site, but rates for procedures used to diagnose and treat a specific disease varied together, as did alternative treatments for the same condition. These results cannot be explained by the actions of a small number of physicians. We do not know whether physicians in high-use areas performed too many procedures, whether physicians in low-use areas performed too few, or whether neither or both of these explanations are accurate. However, we do know that the differences are too large to ignore and that unless they are understood at a clinical level, uninformed policy decisions that have adverse effects on the health of the elderly may be made. (N Engl J Med 1986; 314:285–90.)