The quality and efficiency of the care patients receive is often determined by the accident of where they live and seek care.
Within-[region] variation in spending and utilization is significantly larger than the across [region] variation for both Medicare and Medicaid.”
– Report for the Institute of Medicine.
Which statement is right? Well, both are. Both acknowledge that there exist regional variation in spending and quality. However, it is unclear why one would expect regions to provide exactly the same care as other regions. Another question is, what specific action items are available to reduce cost and improve quality in the high-cost, low-quality regions? You may say, ‘duh’ spend less money. But how to spend less money? Which specific services should be withheld from which specific types of patients? Further, if certain services are withheld, will this actually increase cost due to increased hospitalizations or ER visits?
To improve quality, which providers are responsible for improving these metrics. Care coordination is minimal so in most cases no one provider is responsible for patient outcomes not directly related to the downstream costs of certain procedures.
Thus, I tend to side with the second quotation. I should, after all. I wrote it.