By studying how hospitals treat Medicare patients in their last two years of life, the Dartmouth Atlas of Health Care has found wide geographic differences in how medicine is practiced. The research shows patients in some areas are more likely to get operations and tests than other areas.
The Dartmouth scholarship argues that more care does not always lead to better health, and sometimes can actually harm patients. As a result, Dartmouth believes much of the nation's current medical spending—as much as $700 billion, or 30 percent of the country's $2.5 trillion annual tab—may be not necessary. If the government is able to trim those costs, advocates of health care overhaul legislation believe the savings can help finance an expansion of health insurance to most of the population.
But some dissenters, including University of Pennsylvania medical school professor Dr. Richard "Buz" Cooper, argue Dartmouth overstates the amount of potential waste because its methods don't fully factor in the heavy medical needs of very poor people. In addition, the skeptics say you can't draw conclusions about overall health spending just by studying Medicare patients.
Here are some views on the debate:
Co-Director, Center for Research on Health Care, University of Pittsburgh Graduate School of Public Health
"I think there is a terrific amount of waste, and we certainly have an awful lot of care that is very expensive and has very little value. But that gets us into a discussion that a lot of people don't want to have. One person's waste is another person's health care, so it depends to a certain extent on what we are going to define as valuable and what criteria we are using. You have to figure our how you are going to make people and doctors in [high-cost areas such as] Miami behave like people in [low-cost areas such as] Minnesota."
President, Center for Studying Health System Change
"I think the Dartmouth analysis does show that a lot of the difference in utilization in hospitals or delivery systems in high use areas probably is waste. What Cooper has done is not convincing to me."
Chief Executive Officer, University of Pennsylvania Health System
"The Dartmouth people use Medicare data because that's what's available. It's like a drunk looking for his keys under the lamp post. All of us who run hospitals know it's your total income that determines the breadth and depth of your spending. There are variations among hospitals. There are variations inside hospitals. That's worth looking at. But they're not 30 percent differences."
Professor of Health Policy and Management, Harvard Medical School Department of Health Care Policy
"My general take is that accounting for factor price variation and health status reduces the variation but that it remains substantial. How much of the remaining variation is excessive and unnecessary, however, is more of an open question."
Professor and Senior Health Services Researcher, George Mason University's Department of Health Administration and Policy
"The desire to have a simple solution to a complex issue is very strong. The idea that all spending above the minimum is waste is a very appealing concept. If you're looking for the silver bullet, this looks like a good candidate. The reality is the process of medical care is much more complicated, and I don't think any study does a totally adequate job of controlling for differences in patients' health."
Assistant Vice President on Payment System Reform, The Commonwealth Fund
"The potentially harmful thing is by quibbling about what Dartmouth is implying, he [Cooper] gives what might be perceived as ammunition to people arguing against health reform, and I don't think that's a viable case."
Institute Fellow, Urban Institute
"There is increasing reason to believe Dartmouth didn't do as good a job in risk adjusting for health status. My own experience practicing medicine would suggest there's a lot of wasted spending going on."