Our work, quite literally, has made variation in care delivery visible to
clinicians, researchers, systems leaders, and policy makers around the world.
Medicare patients in Salt Lake City are twice as likely to have a knee or hip replacement as residents of Miami, but the same kinds of patients in Miami receive 60% more care overall than those in Seattle. What could account for such dramatic variation?
At The Dartmouth Institute, beginning with the Dartmouth Atlas of Health Care, our researchers have been working to make sense of health care for decades, revealing these remarkable variations in both practice and spending. Our work, quite literally, has made variation in care delivery visible to clinicians, researchers, systems leaders, and policy makers in the U.S. and around the world.
Doctors who are providing more aggressive care than what is medically recommended are responsible for a significant portion of America’s health care costs—approximately half a trillion dollars annually.
Over one-third of spending on end-of-life care is associated with physician beliefs and is not supported by clinical evidence.
The rate of breast cancer screening for women 75 and over in Sun City, AZ, is more than double that in Miami, FL.
It turns out these striking differences in how we spend health care resources cannot be explained by regional differences in disease or patient preferences; nor are they driven by scientific evidence. And most importantly, more care does not seem to result in better health or happier patients. This means that there are tremendous opportunities to improve care—and lower costs—while still doing better at meeting the health needs and preferences of patients.
At The Dartmouth Institute, researchers analyze data covering more than 70 million Americans, from hospital systems, health care leaders, Medicare, Medicaid, and commercial insurance, to understand what makes high-quality health providers do a better job and how good (or not so good) providers affect others in their network.
By understanding where, for whom, and why care varies, we are uncovering the barriers standing in the way of care that is optimized with clinical evidence and patient preferences—barriers like physician beliefs, institutional structures, and regulatory requirements. Understanding these barriers will allow us to transform care and to build more efficient and sustainable health care systems in the United States and around the world.