Key Issues

Over the past two decades, the Dartmouth Atlas Project has developed a national strategy of providing population-based information describing resource inputs, utilization and outcomes of care across the United States. Much of the variation among regions in per capita resource inputs, utilization and spending has proven to be unwarranted; it cannot be adequately explained on the basis of differences among regions in prices, illness rates, patient characteristics, patient preferences, or the dictates of evidence-based medicine. Much of the variation relates to differences among providers.

The problem of unwarranted variation has attracted widespread attention from the press, policy makers and clinicians interested in quality improvement and health care reform. It has led to legislation promoting demonstration projects to deal with unwarranted variations among the Medicare population. Of particular importance is the evidence that populations living in regions with greater levels of spending and greater use of physician visits and hospitalizations do not experience better health care outcomes or better quality of care. This finding has several implications for patients and for the cost of Medicare. First and foremost, overtreatment harms patients, and it contributes to the chaotic quality of American health care. Second, overtreatment wastes taxpayer dollars. And because of the way Medicare is financed, overtreatment also entails a systematic transfer of tax dollars from residents of low-cost regions to high-cost regions, where those dollars fund the useless, and potentially harmful, care that is being delivered.

Summaries of our findings related to many of these issues and links to further information can be found using the list at right.


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The Dartmouth Atlas of Health Care is based at The Dartmouth Institute for Health Policy and Clinical Practice and is supported by a coalition of funders led by the Robert Wood Johnson Foundation, including the WellPoint Foundation, the United Health Foundation, the California HealthCare Foundation, and the Charles H. Hood Foundation.