TY  - JOUR
AU  - Skinner, Jonathan
AU  - Wennberg, John E
TI  - How Much is Enough? Efficiency and Medicare Spending in the Last Six Months of Life
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 6513
PY  - 1998
Y2  - April 1998
DO  - 10.3386/w6513
UR  - http://www.nber.org/papers/w6513
L1  - http://www.nber.org/papers/w6513.pdf
N1  - Author contact info:
Jonathan S. Skinner
Department of Economics
6106 Rockefeller Hall
Dartmouth College
Hanover, NH 03755
Tel: 603/646-2535
Fax: 603/646-2122
E-Mail: jonathan.skinner@dartmouth.edu
M1  - published as Jonathan S. Skinner, John Wennberg. "How Much Is Enough? Efficiency and Medicare Spending in the Last Six Months of Life," in David M. Cutler, editor, "The Changing Hospital Industry: Comparing Not-for-Profit and For-Profit Institutions" University of Chicago Press (2000)

AB  - In Miami, average inpatient Medicare spending on people in their last six months of life was about double Medicare spending in Minneapolis; average ICU days were nearly four times higher. What are the implications of such differences for the efficiency of health care?  In this paper, we used Medicare claims data to document the extent of these variations across 306 hospital referral regions in the U.S.  We did not find strong evidence that the spending differences were due to underlying variation in health levels across regions.  Nor did we find evidence of any benefits from higher spending levels; regional survival rates following acute conditions like AMI (heart attacks), stroke, and gastrointestinal bleeding were not correlated with more intensive health care spending.  Finally, a number of recent studies suggest that people prefer less, rather than more intensive treatment.  In sum, our results suggest that (i) regions providing more intensive care are not gaining net health benefits over regions providing less care, and (ii) allocative inefficiency may be present, in that patients are not necessarily matched with the treatment they prefer.
ER  -