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Rau J. From California to the New York island, a new understanding of higher Medicare spending. Kaiser Health News [serial on the Internet]. 2011 Mar 8 [cited 2012 Feb 23]. Available from: http://www.kaiser healthnews.org/Stories/2011/ March/09/Geograpic-Differences-In-Medicare-Spending.aspx
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Rau, J.1
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0015756005
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Small area variations in health care delivery
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Wennberg J, Gittelsohn A. Small area variations in health care delivery. Science. 1973;182(4117):1102-8.
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Wennberg, J.1
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The implications of regional variations in Medicare spending. Part 1: the content, quality and accessibility of care
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Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138(4): 273-87.
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Lucas, F.L.5
Pinder, E.L.6
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The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care
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Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138(4): 288-98.
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Lucas, F.L.5
Pinder, E.L.6
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See, for example, materials assembled by the Institute of Medicine for a project to study geographic variation in the intensity and cost of health care services and in per capita health care spending among the Medicare, Medicaid, privately insured, and uninsured US populations. Institute of Medicine. Washington (DC): IOM; 2011 Nov 18 [last updated cited 2012 Apr 3]
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See, for example, materials assembled by the Institute of Medicine for a project to study geographic variation in the intensity and cost of health care services and in per capita health care spending among the Medicare, Medicaid, privately insured, and uninsured US populations. Institute of Medicine. Geographic variation in health care spending and the promotion of highvalue care [Internet]. Washington (DC): IOM; [last updated 2011 Nov 18; cited 2012 Apr 3]. Available from: http://www.iom.edu/ Activities/HealthServices/ GeographicVariation.aspx
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Geographic variation in health care spending and the promotion of highvalue care [Internet]
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The elusive connection between health care spending and quality
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DOI: 10.1377/ hlthaff.28.1w119
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Skinner J, Chandra A, Goodman D, Fisher E. The elusive connection between health care spending and quality. Health Aff (Millwood). 2009;28(1):w119-23. DOI: 10.1377/ hlthaff.28.1w119.
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This view has been challenged by analysts. See, for example, Zuckerman S, Waidmann T, Berenson R, Hadley J
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This view has been challenged by analysts. See, for example, Zuckerman S, Waidmann T, Berenson R, Hadley J. Clarifying sources of geographic differences in Medicare spending. N Engl J Med. 2010;363(1):54-62.
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8
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States with more health care spending have better-quality health care: lessons about Medicare
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DOI: 10.1377/hlthaff .28.1w103
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Cooper R. States with more health care spending have better-quality health care: lessons about Medicare. Health Aff (Millwood). 2009;28(1): w103-15. DOI: 10.1377/hlthaff .28.1w103.
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Health spending by state of residence, 1991-2004
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DOI: 10.1377/hlthaff.26.6w651
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Martin AB, Whittle L, Heffler S, Barron MC, Sisko A, Washington B. Health spending by state of residence, 1991-2004. Health Aff (Millwood). 2007;26(6):w651-63. DOI: 10.1377/hlthaff.26.6w651.
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Washington, B.6
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10
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84917683982
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Centers for Medicare and Medicaid Services. Baltimore (MD): CMS; 2011 Dec 7 [last updated cited 2012 Jan 18]
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Centers for Medicare and Medicaid Services. Health expenditures by state of residence, 1991-2009 [Internet]. Baltimore (MD): CMS; [last updated 2011 Dec 7; cited 2012 Jan 18]. Available from: http:// www.cms.hhs.gov/Research-Statistics-Data-and-Systems/ Statistics-Trends-and-Reports/ NationalHealthExpendData/ NationalHealthAccountsState HealthAccountsResidence.html
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Health expenditures by state of residence, 1991-2009 [Internet]
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11
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84873063360
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We used Urban Institute estimates, which were based on data from the Medicaid Statistical Information System prepared for the Kaiser Commission on Medicaid and the Uninsured. Holahan J, Miller DM, Rousseau D. Dual eligibles: Washington (DC): Kaiser Commission on Medicaid and the Uninsured; 2009 Feb [cited 2012 Apr 3]
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We used Urban Institute estimates, which were based on data from the Medicaid Statistical Information System prepared for the Kaiser Commission on Medicaid and the Uninsured. Holahan J, Miller DM, Rousseau D. Dual eligibles: Medicaid enrollment and spending for Medicare beneficiaries in 2005 [Internet]. Washington (DC): Kaiser Commission on Medicaid and the Uninsured; 2009 Feb [cited 2012 Apr 3]. Available from: http://www.kff.org/medicaid/upload/7846.pdf
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Medicaid enrollment and spending for Medicare beneficiaries in 2005 [Internet]
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12
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84873067147
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CMS.gov. Baltimore (MD): Centers for Medicare and Medicaid Services; 2012 Mar 28 [last modifed cited 2012 Apr 5]
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CMS.gov. Medicaid data sources- general information [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; [last modifed 2012 Mar 28; cited 2012 Apr 5]. Available from: http://www.cms.hhs.gov/medicaiddatasourcesgeninfo/07_maxgeneralinformation.asp
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Medicaid data sources- general information [Internet]
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13
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84873067286
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Note
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Data for Alabama, Arizona, Delaware, Maryland, and North Dakota were excluded. Arizona, Delaware, and Maryland were excluded because a very high proportion of disabled beneficiaries in these states were enrolled in managed care, and the few beneficiaries in fee-for-service were not likely to be representative of other beneficiaries. Alabama and North Dakota were excluded because data anomalies in these states precluded meaningful comparison with data from other states.
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14
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84873071935
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Note
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Acute care spending is defined as all Medicaid spending minus long-term care spending. Long-term care includes nursing facility services, services provided by intermediate care facilities for the mentally retarded, mental hospital services for the aged, services provided by inpatient psychiatric facilities for individuals under age twenty-one, personal care services, targeted case management, residential care, adult day care, and "other services." Expenditures for physician services delivered to hospital inpatients were included in inpatient spending and excluded from ambulatory care spending.
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15
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84873062660
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Note
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We excluded psychiatric admissions mental health services to increase our consistency with Medicare expenditures. We identified inpatient admissions as being psychiatric when they had one of the following International Classification of Diseases, Ninth Revision (ICD-9), diagnosis codes as the primary diagnosis: 293-302, 306-314, 316, and 780.1.
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16
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84860369134
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Dartmouth Institute for Health Policy and Clinical Practice. Lebanon (NH): The Institute; [cited 2011 May 13]
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Dartmouth Institute for Health Policy and Clinical Practice. Dartmouth atlas of health care [Internet]. Lebanon (NH): The Institute; [cited 2011 May 13]. Available from: http://www.dartmouthatlas.org/data/download.shtm
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Dartmouth atlas of health care [Internet]
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84873068054
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Note
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We investigated whether this correlation was sensitive to outliers by excluding the seven highest spending hospital referral regions. The resulting correlation was 0.67 (p< 0:001).
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18
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84873075392
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Note
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To access the Appendix, click on the Appendix link in the box to the right of the article online
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84873072142
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Note
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The lack of a correlation between Medicare and Medi-Cal spending at the regional level within California may be a result of the segregation of care for Medi-Cal patients. Because in many counties Medi-Cal patients receive care from different providers than do Medicare beneficiaries, the availability of resources and practice patterns among physicians serving Medicare beneficiaries may not be as strongly correlated to the availability of resources and practice patterns of physicians serving Medi-Cal beneficiaries. Testing this hypothesis is beyond the scope of this article.
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21
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84873064879
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Note
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Spending at the state level was calculated using CMS National Health Expenditure Accounts data (see Note 10) and weighted by the statelevel population. The correlations are between the percentage of state residents with income below 100 percent of the federal poverty level and expenditures for Medicare, Medicaid, and non-Medicare, non-Medicaid residents.
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