Sources of Geographic Variation in Health Care: Evidence from Patient Migration

We study the drivers of geographic variation in US health care utilization, using an empirical strategy that exploits migration of Medicare patients to separate the role of demand and supply factors. Our approach allows us to account for demand differences driven by both observable and unobservable patient characteristics. Within our sample of over-65 Medicare beneficiaries, we find that 40-50 percent of geographic variation in utilization is attributable to demand-side factors, including health and preferences, with the remainder due to place-specific supply factors. JEL: H51, I1, I11.

[1]  D. Molitor The Evolution of Physician Practice Styles: Evidence from Cardiologist Migration , 2016, American economic journal. Economic policy.

[2]  M. Gaynor,et al.  The Price Ain't Right? Hospital Prices and Health Spending on the Privately Insured , 2015 .

[3]  Raj Chetty,et al.  Active vs. Passive Decisions and Crowdout in Retirement Savings Accounts: Evidence from Denmark , 2012 .

[4]  Daniel P. Kessler,et al.  Patients' preferences explain a small but significant share of regional variation in medicare spending. , 2014, Health affairs.

[5]  E. Ray Dorsey,et al.  The anatomy of health care in the United States. , 2013, JAMA.

[6]  J. Newhouse,et al.  Geographic variation in Medicare services. , 2013, The New England journal of medicine.

[7]  Abe Dunn,et al.  Geographic variation in commercial medical-care expenditures: a framework for decomposing price and utilization. , 2013, Journal of health economics.

[8]  David Card,et al.  Workplace Heterogeneity and the Rise of West German Wage Inequality , 2012, SSRN Electronic Journal.

[9]  S. Mullainathan,et al.  Behavioral Hazard in Health Insurance , 2012, The quarterly journal of economics.

[10]  J. Skinner,et al.  Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Spending , 2013 .

[11]  L. Sheiner,et al.  Why the Geographic Variation in Health Care Spending Cannot Tell Us Much about the Efficiency or Quality of Our Health Care System , 2012 .

[12]  Emmanuel Saez,et al.  Using Differences in Knowledge Across Neighborhoods to Uncover the Impacts of the EITC on Earnings , 2013 .

[13]  Sebastian Negrusa,et al.  Geographic Variation in Health Care Spending and Promotion of High-Value Care (part of IOM Report, coordinated by J. Newhouse, A. Garber et al.) , 2012 .

[14]  J. Skinner,et al.  Cost Growth in Medicare: 1992 to 2006 , 2011 .

[15]  D. Wise Explorations in the Economics of Aging , 2011 .

[16]  J. Skinner,et al.  Geographic variation in diagnosis frequency and risk of death among Medicare beneficiaries. , 2011, JAMA.

[17]  Amitabh Chandra,et al.  Who Ordered That? The Economics of Treatment Choices in Medical Care , 2011 .

[18]  J. Skinner Causes and Consequences of Regional Variations in Health Care , 2011 .

[19]  Bart J. Bronnenberg,et al.  The Evolution of Brand Preferences: Evidence from Consumer Migration , 2010 .

[20]  Jack Hadley,et al.  Clarifying sources of geographic differences in Medicare spending. , 2010, The New England journal of medicine.

[21]  Julie Bynum,et al.  Regional variations in diagnostic practices. , 2010, The New England journal of medicine.

[22]  J. Skinner,et al.  Prices don't drive regional Medicare spending variations. , 2010, Health affairs.

[23]  S. Seabury,et al.  Geographic Variation in Health Care: The Role of Private Markets , 2010 .

[24]  J. Newhouse,et al.  Geographic correlation between large-firm commercial spending and Medicare spending. , 2010, The American journal of managed care.

[25]  Thomas H. Lee,et al.  Chaos and Organization in Health Care , 2009 .

[26]  A. Belloni,et al.  Least Squares After Model Selection in High-Dimensional Sparse Models , 2009, 1001.0188.

[27]  Elliott S Fisher,et al.  Variations in hospital resource use for Medicare and privately insured populations in California. , 2008, Health affairs.

[28]  J. Skinner,et al.  Are Regional Variations in End-of-Life Care Intensity Explained by Patient Preferences?: A Study of the US Medicare Population , 2007, Medical care.

[29]  Amitabh Chandra,et al.  Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks , 2007, Journal of Political Economy.

[30]  P. Lapuerta,et al.  Geographic variation in health care utilization and outcomes in veterans with acute myocardial infarction , 2002, Journal of General Internal Medicine.

[31]  W. MacLeod,et al.  First Do No Harm?: Tort Reform and Birth Outcomes , 2006 .

[32]  Raquel Fernández,et al.  Fertility: The Role of Culture and Family Experience , 2005 .

[33]  James N Weinstein,et al.  Trends and geographic variations in major surgery for degenerative diseases of the hip, knee, and spine. , 2004, Health affairs.

[34]  Lisa I. Iezzoni,et al.  Risk Adjustment of Medicare Capitation Payments Using the CMS-HCC Model , 2004, Health care financing review.

[35]  David Wennberg,et al.  The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care , 2003, Annals of Internal Medicine.

[36]  David Wennberg,et al.  The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care , 2003, Annals of Internal Medicine.

[37]  The Implications of Regional Variations in Medicare Spending: The Content, Quality, and Accessibility of Care , 2003, Annals of Internal Medicine.

[38]  R. Creecy,et al.  Computing Person and Firm Effects Using Linked Longitudinal Employer-Employee Data , 2002 .

[39]  K W Kizer,et al.  Geographic variations in utilization rates in Veterans Affairs hospitals and clinics. , 1999, The New England journal of medicine.

[40]  Daniel Aaronson,et al.  Using sibling data to estimate the impact of neighborhoods on children's educational outcomes , 1998 .

[41]  G. Coffman,et al.  Chronic conditions and risk of in-hospital death. , 1994, Health services research.

[42]  Kevin M. Murphy,et al.  A Theory of Rational Addiction , 1988, Journal of Political Economy.

[43]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.

[44]  C. Morris Parametric Empirical Bayes Inference: Theory and Applications , 1983 .

[45]  K. McPherson,et al.  Regional variations in the use of common surgical procedures: within and between England and Wales, Canada and the United States of America. , 1981, Social science & medicine. Part A, Medical sociology.