In the wake of this year’s landmark health care reform legislation, one of the most hotly debated topics comes courtesy of the Dartmouth Atlas of Health Care (www.dartmouthatlas.org), as politicians, analysts, researchers and physicians grapple over how to resolve the contentious issue of geographical disparities in health care spending.
Explore this issue:August 2010
One of the main bodies of evidence driving the debate, the interactive Dartmouth map, depicts a color-coded nation in which wide swaths of the upper Midwest and West are colored with a pale yellow hue, which represents areas receiving significantly reduced amounts of Medicare reimbursement. Meanwhile, states such as California, New York, New Jersey, Massachusetts, Florida, Texas and Louisiana are marked by a darker shade of brown, which represents the nation’s most expensive per capita reimbursement rates.
The implicit message is that some states, cities and health providers have been shortchanged in their reimbursements—a complaint that flows into the larger meme that the country’s dysfunctional payment system rewards quantity, not quality. Officials at the Rochester, Minn.-based Mayo Clinic, for example, have suggested in media accounts that the current Medicare formula cost the clinic $840 million in lost reimbursements in 2008 alone, the result of what they deem inadequate rates that don’t reflect the true cost of care for older patients.