Geographic differences in US health care spending

摘要

To the Editor In their Viewpoint regarding the Institute of Medicine (IOM) report on geographic variation in health care spending, Drs Newhouse and Garber1 indicated the spending data were adjusted for geographically different input prices.Use of a flawed input price-adjustment method leaves many of the IOM report's conclusions in doubt. The input price adjustment did not use the actual dollars spent on physician work but used geographic practice cost index (GPCI) adjusters to change the spending figures to reflect local differences in input price.The problem is that the GPCI does not use real data on physician labor prices for determining the adjustment but instead uses the wages of other professionals by region to set the price of physician labor. The GPCI adjustments have never used actual physician compensation figures, and there has never been proof of a relationship between the wages of other professionals and physicians by region.The Medicare Payment Advisory Commission has stated "the current GPCI is flawed in concept and implementation" and urged Congress to "direct the Secretary to develop an adjuster to replace it."