A map to bad policy--hospital efficiency measures in the Dartmouth Atlas.

Peter B. Bach, M.D., M.A.P.P. I n showing that regional spending variations do not correlate with differences in disease burden or outcome, the Dartmouth Atlas of Health Care has felled the notion that higher health care spending necessarily leads to improved health outcomes. Policymakers have seized on two possible ways to wring savings out of this information. The health care reform bill passed by the House of Representatives contains provisions for identifying regions where Medicare spending appears disproportionately high and adjusting payment rates accordingly. And some policymakers, including President Barack Obama, have proposed that the features of highperforming, “efficient” health care systems should be identified and their lower-cost practices emulated. Dartmouth Atlas researchers have also begun attempting to convert their observations into costsaving policies. By analyzing Medicare claims for Looking Back, Moving Forward