Don't like your diagnosis? Maybe you should move

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By Julie Steenhuysen | May 15, 2010 2:07 AM EST

Doctors in some parts of the United States are more likely to tell Medicare patients they are sick than in other parts, researchers said on Wednesday in a finding that could explain regional differences in health spending.

The study is the latest from the Dartmouth Atlas Project, which last year uncovered wide differences spending by region, a finding that became a touchstone in the debate about the need for healthcare reform in the United States.

Controlling spending will be one of the biggest challenges of U.S. health reform legislation passed in March.

"Our study shows that there are big regional differences in the tendency to give new diagnoses to Medicare beneficiaries," said Yunjie Song of the Dartmouth Institute for Health Policy and Clinical Practice, whose study was one of a series appearing in the New England Journal of Medicine.

"What we still don't know is whether being given more diagnoses is better for patients," Song said in a statement.

Song and colleagues followed 255,264 Medicare beneficiaries for five years, comparing those who moved to a region where patients receive more hospital and physician services to those who moved to places where patients typically get less care.

All of the patients had more diagnoses as they aged. But people who moved from the lowest-intensity to the highest-intensity treatment regions had a far greater increase in the number of diagnoses.

Dartmouth's Dr. Elliott Fisher said nearly all older Americans have some form of heart disease, but in some regions doctors were more likely to test for it and inform patients they have it.

"We need to do more research to understand when it is actually helpful to do these additional tests and tell more people that they are sick," Fisher said in a statement.

REGIONAL HEALTH DIFFERENCES

Differences in spending may simply reflect regional differences in health, a team from George Mason University and the Urban Institute in Virginia reported in a separate study.

"Our study shows that an individual's health explains almost one-third of the difference in Medicare spending per beneficiary between the highest and lowest cost areas," Stephen Zuckerman of the Urban Institute's Health Policy Center said in a statement.

The team analyzed Medicare spending on 6,725 patients collected from 2000-2002 and found Medicare spending per beneficiary ranged from an average of $4,721 in the least expensive regions to $7,183 in the most expensive regions.

But 29 percent of the difference was based on health differences, and only 33 percent remained unexplained.

Zuckerman said conventional wisdom about large, unexplained geographic differences in Medicare spending overstate the problem and could wrongly reward or penalize certain areas.

Dr. Arnold Epstein of the Harvard School of Public Health, who wrote a commentary in the journal, said the studies offer a reminder that there is clearly variation in the way doctors practice medicine as they seek to give their patients the best care they know how.

"I don't think we've uncovered why clumps of doctors do things in certain ways," he said in a telephone interview.

Studies that give doctors more scientific information about which therapies work best for which patients would help, especially if they were accessible through an electronic medical record.

"And I think we can do something with incentives to set the thermometer so the doctor is constantly asking, 'Does the patient really need this?'" said Epstein.

(Editing by Chris Wilson)

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