Geographic Variation in Health Care Spending

Notes The map on the cover was generated by the Congressional Budget Office from data supplied by the Centers for Medicare and Medicaid Services. The map illustrates Medicare spending per beneficiary in the fee-for-service program on the basis of beneficiaries' residences. (The data were adjusted for age, sex, and race.) The geographic unit is the hospital referral region, as defined by the Dartmouth Atlas of Health Care. Unshaded areas are places without residents, such as national parks, forests, lakes, and islands. Unless otherwise noted, all years are calendar years. Because of rounding, the sums of numbers in the text and tables may not equal totals. Preface Pe r capita health care spending and patterns of medical practice vary widely across the United States. In this paper, written at the request of the Chairman of the Senate Budget Committee, the Congressional Budget Office (CBO) examines the amount of geographic variation in spending, the reasons for that variation, and its implications for evaluating the efficiency of the health care system. In keeping with CBO's mandate to provide objective, impartial analysis, the paper makes no policy recommendations. (The assistance of external reviewers implies no responsibility for the final product, which rests solely with CBO.) Michael Treadway and Kate Kelly edited the report, and Christine Bogusz proofread it. Maureen Costantino designed and produced the cover, with assistance from Alshadye Yemane, and prepared the report for publication. Lenny Skutnik produced the printed copies, Linda Schimmel coordinated the print distribution, and Simone Thomas prepared the electronic version for CBO's Web site (www.cbo.gov).