Geographic Variation in the Volume and Intensity of Medicare Physician Servicesin 1988: A Descriptive Analysis

摘要

The study presents a comprehensive description of the extent of cross-sectionalgeographic variation in Medicare physician services use rates across all services and across the U.S. Using 1988 Part B Medicare Annual Data, a measure of volume and intensity (V/I) was derived that captures differences in use rates across all services to decompose area variations in expenditures per enrollee into the component due to price and that due to V/I. There are substantial geographic differences in V/I of physician services provided to Medicare beneficiaries, varying by a factor 3.5 from highest to lowest and by 1.7 in the 95th to the 5th percentile. The degree of variation varies across service categories with substantially more variation for consultations, home and nursing home visits, minor procedures, oncology services, and laboratory tests than there is for office visits, all categories of major procedures, endoscopies and standard imaging. The findings have implications for the implementation of a subnational volume performance standard (VPS) policy. It suggests that a uniform policy treats areas of very high utilization levels no differently from areas with low utilization levels. Subnational VPS may need to consider setting standards inversely with current levels of utilization. Base levels of utilization might need to be a factor considered in determining the rate of growth in setting VPS.