The New Health Dialogue

Our bloggers will be out and about today, so we'll point you to two very useful posts (here and here) over at Maggie Mahar's Healthbeat blog critiquing the New York Times critique of the Dartmouth Atlas research into geographic variation. Maggie talked to some of the people who were portrayed as critics -- but they aren't really so critical. They may have some questions or quibbles with details in the data sets, as one of them put it, but they basically agree with the overall findings and thrust of the Dartmouth research: that there is indeed wide (and sometimes not fully explicable) variation in health care. McAllen is real. Here's what Mahar heard from one Yale expert quoted in the Times:

Harlan M. Krumholz, a professor of medicine and health policy expert at Yale also was quoted as if he doubted the basic thrust of Dartmouth’s work. The Times’ reporters  used  just one line  from his interview:  “It may be that some places that are spending more are actually getting better results.” Today, Krumholz explained: “What I spent most of the interview trying to convey is that a lot of the back and forth [about bits and pieces of Dartmouth’s data ] is inside baseball stuff – and we are all working hard to figure out how to gauge costs and value better. But Dartmouth’s work on variation is pivotal to moving us forward – and we all agree that there is lots of waste and it is unevenly distributed across the country.

Some other pushback -- including the Dartmouth's researchers own rebuttal -- we shared with you here last week. None of this means that the Dartmouth work shouldn't be examined and discussed -- MedPac for instance has raised some important questions (including some observations about regional variation in spending versus regional variation in use of services) when it looked at geographic variation. There are questions, too, about communities where Medicare spending is relatively low but other health care sectors are high. With a lot riding on getting the incentives and the risk adjustments and the new payment models right under health care, it's certainly fair to raise questions. But be careful about the context of the answers.