The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care
- Elliott S. Fisher, MD, MPH;
- David E. Wennberg, MD, MPH;
- Thérèse A. Stukel, PhD;
- Daniel J. Gottlieb, MS;
- F. L. Lucas, PhD; and
- É toile L. Pinder, MS
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From Center for Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire; VA Outcomes Group, White River
Junction Veterans Affairs Medical Center, White River Junction, Vermont; and Institute for the Clinical Evaluative Sciences,
Toronto, Ontario, Canada.
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Figure 1. Circles represent adjusted relative risk for death among residents of hospital referral regions in the specified
quintile of the End-of-Life Expenditure Index (EOL-EI) compared to the risk for death among residents of hospital referral
regions in quintile 1 of the EOL-EI; bars represent 95% CIs. MCBS = Medicare Current Beneficiary Survey; MI = myocardial infarction;
Q1 = quintile 1; Q2 = quintile 2; Q3 = quintile 3; Q4 = quintile 4; Q5 = quintile 5. Adjusted relative risk for death during follow-up across quintiles of Medicare spending.
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Figure 2. Income figures refer to the average monthly Social Security income of the patients' ZIP codes. Circles represent
the adjusted relative risk for death associated with a 10% increase in the End-of-Life Expenditure Index across U.S. hospital
referral regions; bars represent 95% CIs for the relative risk. *Mid-Atlantic, South Atlantic, and Great Lakes regions. †Did
not change hospital referral region of residence in the 1 to 2 years before index admission. HMO = health maintenance organization. Adjusted relative risk for death associated with a 10% increase in Medicare spending overall and among specified subgroups
of the hip fracture cohort.
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Figure 3. Income figures refer to the average monthly Social Security incomes of the patients' ZIP code. Circles represent
the adjusted relative risk for death associated with a 10% increase in the End-of-Life Expenditure Index across U.S. hospital
referral regions; bars represent 95% CIs for the relative risk. *Mid-Atlantic, South Atlantic, and Great Lakes regions. †Did
not change hospital referral region of residence in the 1 to 2 years before index admission. HMO = health maintenance organization. Adjusted relative risk for death associated with a 10% increase in Medicare spending overall and among specified subgroups
of the colorectal cancer cohort.
-
Figure 4. ) cohort. Income figures refer to the average monthly Social Security income of the patients' ZIP codes. Circles
represent the adjusted relative risk for death associated with a 10% increase in the End-of-Life Expenditure Index across
U.S. hospital referral regions; bars represent 95% CIs for the relative risk. *Mid-Atlantic, South Atlantic, and Great Lakes
regions. †Did not change hospital referral region of residence in the 1 to 2 years before index admission. HMO = health maintenance
organization. Adjusted relative risk for death associated with a 10% increase in Medicare spending overall and among specified subgroups
of the acute myocardial infarction ( MI
-
Figure 5. An arrow pointing upward indicates a positive association between increased spending and satisfaction. Bars represents
95% CIs. Q1 = quintile 1; Q5 = quintile 5. Satisfaction with care.
- Copyright ©2004 by the American College of Physicians
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Ann Intern Med
February 18, 2003
vol. 138
no. 4
288-298
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Figure 1. Circles represent adjusted relative risk for death among residents of hospital referral regions in the specified quintile of the End-of-Life Expenditure Index (EOL-EI) compared to the risk for death among residents of hospital referral regions in quintile 1 of the EOL-EI; bars represent 95% CIs. MCBS = Medicare Current Beneficiary Survey; MI = myocardial infarction; Q1 = quintile 1; Q2 = quintile 2; Q3 = quintile 3; Q4 = quintile 4; Q5 = quintile 5. Adjusted relative risk for death during follow-up across quintiles of Medicare spending.
Figure 2. Income figures refer to the average monthly Social Security income of the patients' ZIP codes. Circles represent the adjusted relative risk for death associated with a 10% increase in the End-of-Life Expenditure Index across U.S. hospital referral regions; bars represent 95% CIs for the relative risk. *Mid-Atlantic, South Atlantic, and Great Lakes regions. †Did not change hospital referral region of residence in the 1 to 2 years before index admission. HMO = health maintenance organization. Adjusted relative risk for death associated with a 10% increase in Medicare spending overall and among specified subgroups of the hip fracture cohort.
Figure 3. Income figures refer to the average monthly Social Security incomes of the patients' ZIP code. Circles represent the adjusted relative risk for death associated with a 10% increase in the End-of-Life Expenditure Index across U.S. hospital referral regions; bars represent 95% CIs for the relative risk. *Mid-Atlantic, South Atlantic, and Great Lakes regions. †Did not change hospital referral region of residence in the 1 to 2 years before index admission. HMO = health maintenance organization. Adjusted relative risk for death associated with a 10% increase in Medicare spending overall and among specified subgroups of the colorectal cancer cohort.
Figure 4. ) cohort. Income figures refer to the average monthly Social Security income of the patients' ZIP codes. Circles represent the adjusted relative risk for death associated with a 10% increase in the End-of-Life Expenditure Index across U.S. hospital referral regions; bars represent 95% CIs for the relative risk. *Mid-Atlantic, South Atlantic, and Great Lakes regions. †Did not change hospital referral region of residence in the 1 to 2 years before index admission. HMO = health maintenance organization. Adjusted relative risk for death associated with a 10% increase in Medicare spending overall and among specified subgroups of the acute myocardial infarction ( MI
Figure 5. An arrow pointing upward indicates a positive association between increased spending and satisfaction. Bars represents 95% CIs. Q1 = quintile 1; Q5 = quintile 5. Satisfaction with care.
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