How does the quality and quantity of health care delivered in California stack up to the rest of the country?
Not so well, according to a 2008 Dartmouth Atlas Project report on California commissioned by the nonprofit California HealthCare Foundation.
The Dartmouth Atlas Project has, in two decades of research, uncovered striking variations in the quality and quantity of health care delivered across the United States, even taking into account differences in demographics and degrees of illness. Care also varies dramatically within states.
And California is no exception.
California ranks in the bottom 25 percent for quality, as well as for avoidable hospital use and costs, according to the 2007 Commonwealth Fund State Scorecard on Health System Performance. In other words, our quality of care is trailing even though our providers deliver more services while we spend more per capita on our Medicare patients than three quarters of the country.
A few examples, courtesy of the Dartmouth Atlas Project, which for two decades has used Medicare data to track nationwide variation in health-care practices and spending:
The U.S. Preventive Services Task Force recommends a mammogram screening every one to three years for women age 40 and older. Yet just 59 percent of California women statewide aged 65 to 69 received the recommended screening, which places California in the bottom quarter of states, just above Mississippi, at 57 percent of women screened, and well below Maine’s 74 percent.
Regions in which a greater proportion of care is provided by primary care physicians have both better quality care and lower costs. But in California, only 72 percent of Medicare enrollees have a primary care physician as their main doctor. Statewide, the percentage of Medicare enrollees with a primary care physician as their main doctor ranged from 60 percent in the Palm Springs/Rancho Mirage area to 87 percent in Redding. Nationally, 44 other states have higher rates of Medicare enrollees who have a primary care physician.
When it comes to Medicare spending only New Jersey and New York enrollees have higher costs than California enrollees during the last two years of life. All three states spend more than 20 percent above the national average of $46,412 per Medicare enrollee over the last two years of life.
The 2008 Dartmouth report found that total Medicare spending for chronic illnesses such as diabetes, cancer and heart disease in the last two years of life cost on average $93,842 per beneficiary at UCLA Medical Center, but just $53,432 at the Mayo Clinic's main teaching hospital in Minnesota, which is considered the gold standard for care.
Even more striking were the differences in spending for the last six months of life -- $52,911 per patient at UCLA Medical Center and $28,763 per patient at the Mayo Clinic hospital. What explains this wide discrepancy? The prices that Medicare pays for medical services in California and Minnesota were not that different. The difference is explained by the amount of care patients in their last six months of life received at UCLA Medical Center compared with the Mayo Clinic. In their last six months, patients in Los Angeles had more than twice as many physician visits as Mayo patients and spent almost 50 percent more days hospitalized.
Medicare costs were higher for patients in Southern California, where elderly patients were more likely to be hospitalized and to spend time in an intensive care unit, than they were in the northern part of the state. But the quality of care is not measurably better in the south, researchers found. In fact, higher hospitalization rates meant more patients were at risk for medical errors and hospital-acquired infections.
Dartmouth researchers found that in areas like Southern California, where Medicare spending is among the highest in the nation, elderly patients neither live longer nor experience a better quality-of-life than those in areas where spending is lowest. Indeed, Medicare enrollees living in higher-spending areas were slightly less likely to get recommended follow-up care.
Improved availability of trusted and accessible scientific evidence coupled with incentives to encourage doctors and patients to make use of the information could have a big impact on the overuse, underuse and misuse of medical care described in the data above. More and better use of trusted scientific evidence by California doctors and patients can lead us to less waste and increased patient safety and well-being for all Californians.
Not so well, according to a 2008 Dartmouth Atlas Project report on California commissioned by the nonprofit California HealthCare Foundation.
The Dartmouth Atlas Project has, in two decades of research, uncovered striking variations in the quality and quantity of health care delivered across the United States, even taking into account differences in demographics and degrees of illness. Care also varies dramatically within states.
And California is no exception.
California ranks in the bottom 25 percent for quality, as well as for avoidable hospital use and costs, according to the 2007 Commonwealth Fund State Scorecard on Health System Performance. In other words, our quality of care is trailing even though our providers deliver more services while we spend more per capita on our Medicare patients than three quarters of the country.
A few examples, courtesy of the Dartmouth Atlas Project, which for two decades has used Medicare data to track nationwide variation in health-care practices and spending:
The U.S. Preventive Services Task Force recommends a mammogram screening every one to three years for women age 40 and older. Yet just 59 percent of California women statewide aged 65 to 69 received the recommended screening, which places California in the bottom quarter of states, just above Mississippi, at 57 percent of women screened, and well below Maine’s 74 percent.
Regions in which a greater proportion of care is provided by primary care physicians have both better quality care and lower costs. But in California, only 72 percent of Medicare enrollees have a primary care physician as their main doctor. Statewide, the percentage of Medicare enrollees with a primary care physician as their main doctor ranged from 60 percent in the Palm Springs/Rancho Mirage area to 87 percent in Redding. Nationally, 44 other states have higher rates of Medicare enrollees who have a primary care physician.
When it comes to Medicare spending only New Jersey and New York enrollees have higher costs than California enrollees during the last two years of life. All three states spend more than 20 percent above the national average of $46,412 per Medicare enrollee over the last two years of life.
The 2008 Dartmouth report found that total Medicare spending for chronic illnesses such as diabetes, cancer and heart disease in the last two years of life cost on average $93,842 per beneficiary at UCLA Medical Center, but just $53,432 at the Mayo Clinic's main teaching hospital in Minnesota, which is considered the gold standard for care.
Even more striking were the differences in spending for the last six months of life -- $52,911 per patient at UCLA Medical Center and $28,763 per patient at the Mayo Clinic hospital. What explains this wide discrepancy? The prices that Medicare pays for medical services in California and Minnesota were not that different. The difference is explained by the amount of care patients in their last six months of life received at UCLA Medical Center compared with the Mayo Clinic. In their last six months, patients in Los Angeles had more than twice as many physician visits as Mayo patients and spent almost 50 percent more days hospitalized.
Medicare costs were higher for patients in Southern California, where elderly patients were more likely to be hospitalized and to spend time in an intensive care unit, than they were in the northern part of the state. But the quality of care is not measurably better in the south, researchers found. In fact, higher hospitalization rates meant more patients were at risk for medical errors and hospital-acquired infections.
Dartmouth researchers found that in areas like Southern California, where Medicare spending is among the highest in the nation, elderly patients neither live longer nor experience a better quality-of-life than those in areas where spending is lowest. Indeed, Medicare enrollees living in higher-spending areas were slightly less likely to get recommended follow-up care.
Improved availability of trusted and accessible scientific evidence coupled with incentives to encourage doctors and patients to make use of the information could have a big impact on the overuse, underuse and misuse of medical care described in the data above. More and better use of trusted scientific evidence by California doctors and patients can lead us to less waste and increased patient safety and well-being for all Californians.