Download

Download Free Electronic Document

FormatFile SizeNotes
PDF file 0.6 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Purchase

Purchase Print Copy

 FormatList Price Price
Add to Cart Paperback6 pages $20.00 $16.00 20% Web Discount

This Note is reprinted from the New England Journal of Medicine, v. 314, January 30, 1986. The authors measured geographic differences in the use of medical and surgical services during 1981 by Medicare beneficiaries (age 65 or over) in 13 large areas of the United States. The average number of Medicare beneficiaries per site was 340,000. They 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. It is not clear 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 is accurate. The differences are too large to ignore, however, and unless they are understood at a clinical level, uninformed policy decisions that have adverse effects on the health of the elderly may be made.

This report is part of the RAND Corporation note series. The note was a product of the RAND Corporation from 1979 to 1993 that reported other outputs of sponsored research for general distribution.

Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. For information on reprint and linking permissions, please visit the RAND Permissions page.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.