Browse > Article
http://dx.doi.org/10.4332/KJHPA.2007.17.1.094

Research on Geographic Variations in Health Services Utilization in the United States: A Critical Review and Implications  

Do, Young-Kyung (Department of Health Policy and Administration University of North Carolina at Chapel Hill School of Public Health)
Publication Information
Health Policy and Management / v.17, no.1, 2007 , pp. 94-124 More about this Journal
Abstract
This paper critically reviews three decades of research on geographic variations. in health services utilization in the United States, thereby drawing policy and research implications for Korea. The recent renewed interest in variations research in the United States, precipitated by studies on regional variations in Medicare expenditures, stems mainly from the policy implication that a substantial amount of Medicare expenditures could be saved without compromising quality and access. From the research perspective, this policy implication was made tenable by integrating micro- and macro-level analysis of variations in health services utilization. Still, theoretical limitations inherent in the research pose great challenges to developing effective strategies at the health system level. Variations research in the United States can serve as a case study as to how health services research has responded to efficiency and quality issues in an ever expanding health system Considering the current health policy and research environment in Korea, the following implications can be drawn. Variations research will help formulate a national policy agenda for health care quality and also advance the framework of approaches to health policy issues. For such purposes, both relevant descriptive and hypothesis-testing studies are needed. Further advancement in variations research will require interdisciplinary explorations and methodological sophistication. To the extent that Korean health policies will strive to achieve complex goals, variations research will increasingly prove to be useful.
Keywords
Variations research; Small area analysis; Health services research; Korea;
Citations & Related Records
Times Cited By KSCI : 3  (Citation Analysis)
연도 인용수 순위
1 조우현,이선희,박은철,손명세,김세라. 지역간 입원 비용 변이에 관한 연구. 예방의학회지 1994;27(3):609-626
2 Aday LA,Andersen R. A framework for the study of access to medical care. Healht Serv Res. 1974;9:208-220
3 Cutler DM. Making sense of medical technology. Health Aff. 2006;25:w48-50   DOI   ScienceOn
4 Cutler DM, Sheiner L. The geography of Medicare. Am Econ Rev. 1999;89:228-233   DOI   ScienceOn
5 건강보험심사평가원. 진료정보안내. Available from: URL:http://www.hira.or.kr/cms/rd/index_04_new.html Accessed July 18,2006
6 김윤,김용익,신영수. 일부 다빈도 상병에서 입원진료비의 변이 정도와 요인에 대한 연구. 보건행정학회지 1993;3(1):25-52
7 김윤미,양봉민. 일반외과 영역 다빈도 수술률의 소규모 지역간 변이. 보건행정학회지 2004;14(2):138-162
8 Cleary PD, McNeil BJ, Patient satisfaction as an indicator of quality care. Inquiry. 1988;25:25-36
9 Cochrane AL. Effectiveness and Efficiency. London: Abingdon, Berks Nuffield Provincial Hospitals Trust;1972
10 김창석,윤성철,김혜련,강영호. 서울시 동별 상류계층(파워엘리트) 주거 분포와 흡연과의 관련성에 대한 다수준분석. 예방의학회지 2006;39(1):30-38   과학기술학회마을
11 김혜경,이정운,박강원,문옥륜. 제왕절개 분만율의 지역간 변이와 관련요인에 대한 연구. 예방의학회지 1992;25(3):312-329
12 남정모,이선희,조우현. 지역간 의료이용 변이지표의 통계학적 분포와 검정에 대한 연구. 예방의학회지 1999;32(1):80-87
13 박실비아. 일부 다빈도 질환에서 의료기관 유형별 의약품 사용의 변이. 보건행정학회지 1999(2):118-138
14 신영전,이원영,문옥륜. 의료이용의 지역간 격차: 3차성 내과계 진단군을 중심으로. 보건행정학회지 1999;9(1):72-109
15 안형식,권영대,김명기,김용익,신영수. 제왕절개 분만율의 지역간 변이에 영향을 미치는 의료기관 특성요인 분석. 보건행정학회지 1991;1(1):27-41
16 이선희,조우현,남정모,김석일. 일부 다빈도 진단명들의 지역간 의료이용 변이. 보건행정학회지 1994;4(1):49-76
17 Fisher ES, Wennberg JE, Stukel TA, et al. Associations among hospital capacity, utilization, and mortality of US medicare beneficiaries, controlling for sociodemographic factors. Health Serv Res. 2000;34:1351-1362
18 Bach PB,Schrag D,Begg CB. Resurrecting treatment histories of dead patients: A study design that should be laid to rest. JAMA. 2004;292:2765-2770   DOI   ScienceOn
19 Fuchs, VR, McClellan, M, Skinner, J. Area differences in utilization of medical care and mortality among U.S. elderly. NBER Working Paper No. 8628. Cambridge, MA: National Bureau of Economic Research.2001
20 Alexander JA,Lee SY,Griffith JR,Mick SS,Lin X,Banaszak-Holl J. Do market-level hospital and physician resources affect small area variation in hospital use? Med Care Res Rev. 1999;56:94-117   DOI
21 Blumenthal D. The variation phenomenon in 1994. N Engl J Med. 1994;331:1017-1018   DOI   ScienceOn
22 Blumenthal D. Quality of health care. Part 4: The origins of the quality-of-care debate. N Engl J Med. 1996;335:1146-1149   DOI   ScienceOn
23 Bodenheimer TS,Grumbach K. Understanding health policy: A clinical approach. 4th ed. New York,NY: McGraw-Hill;2005
24 Brook RH,Lohr K,Chassin M,Kosecoff J,Fink A,Solomon D. Geographic variations in the use of services: Do they have any clinical significance? Health Aff. 1984;3:63-73
25 Brown LD. Political evolution of federal health care regulation. Health Aff. 1992;11:17-37   DOI
26 Carlsen F, Grytten J. More physicians: Improved availability or induced demand? Health Econ. 1998;7:495-508   DOI   ScienceOn
27 Chassin MR. Explaining geographic variations. The enthusiasm hypothesis. Med Care. 1993;31:YS37-44
28 Phelps CE, Mooney C. Variations in medical practice use: Causes and consequences. In: Arnould RJ, Rich RF, White W, eds. Competitive approaches to health care reform. Washington, DC: The Urban Institute Press;1993
29 Diehr P. Small area statistics: Large statistical problems. Am J Public Health. 1984;74:313-314   DOI
30 de Jong JD, Westert GP, Lagoe R, Groenewegen PP. Variation in hospital length of stay: Do physicians adapt their length of stay decisions to what is usual in the hospital where they work? Health Serv Res. 2006;41:374-394   DOI   ScienceOn
31 Diehr P, Cain K, Connell F, Volinn E. What is too much variation? The null hypothesis in small-area analysis. Health Serv Res. 1990;24:741-771
32 Diehr P, Cain KC, Kreuter W, Rosenkranz S. Can small-area analysis detect variation in surgery rates? The power of small-area variation analysis. Med Care. 1992;30:484-502   DOI   ScienceOn
33 Donabedian A, Wheeler JR, Wyszewianski L. Quality, cost, and health: An integrative model. Med Care. 1982;20:975-992   DOI   ScienceOn
34 Fisher ES, Welch HG. Avoiding the unintended consequences of growth in medical care: How might more be worse? JAMA. 1999;281:44&453
35 Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: The content, quality, and accessibility of care. Ann Intern Med. 2003a;138:273-287   DOI   ScienceOn
36 Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: Health outcomes and satisfaction with care. Ann Intern Med. 2003b;138:288-298   DOI   ScienceOn
37 Fisher ES, Wennberg JE. Health care quality, geographic variations, and the challenge of supply-sensitive care. Perspect Biol Med. 2003;46:69-79   DOI
38 Iglehart JK. From the editor. Special issue: Variations in medical practice. Health Aff. 1984;3(2)
39 Kissick WL. Medicine's Dilemmas: Infinite needs versus finite resources. New Haven: Yale University Press;1994
40 Iglehart JK. Editor's note. Variations revisited. Health Aff. 2004;Suppl Web Exclusive.VAR3-4
41 McGlynn EA. Six challenges in measuring the quality of health care. Health Aff. 1997;16:7-21
42 Medicare Payment Advisory Commission (MedPAC). Report to the Congress: Variation and innovation in Medicare. Washington, DC MedPAC;2003
43 Melhado EM. Health planning in the United States and the decline of public-interest policymaking. Milbank Q. 2006;84:359-440   DOI   ScienceOn
44 O'Connor AM, Llewellyn-Thomas HA, Flood AB. Modifying unwarranted variations in health care: Shared decision making using patient decision aids. Health Aff. 2004;Suppl Web Exclusive:VAR63-72
45 Oleske DM. Epidemiology and the delivery of health care services: Methods and applications. 2nd ed. New York, NY: Kluwer Academic Publishers;2001
46 Paul-Shaheen P, Clark JD, Williams D. Small area analysis: A review and analysis of the North American literature. J Health Polit Policy Law. 1987;12:741-809   DOI
47 Pauly MV, Feldman R, Eisenberg JM, Erder MR, Schwartz JS. Paying physicians: Options for controlling cost, volume, and intensity of services. Ann Arbor, MI: Health Administration Press;1992
48 Glover JA. The incidence of tonsillectomy in school children. Proc R Soc Med. 1938;31:1219-1236
49 Grumbach K, Bodenheimer T. Reins or fences: A physician's view of cost containment. Health Aff. 1990;9:120-126   DOI
50 Phelps CE. Information diffusion and best practice adoption. In: Cuyler AJ, Newhouse JF, eds. Handbook of Health Economics. Vol 1. Amsterdam, The Netherlands: Elsevier Science; 2000:223-264
51 Roemer MI. Bed supply and hospital utilization: A natural experiment Hospitals. 1961;35:36-42
52 Skinner, JS, Fisher, E, Wennberg, JE. The efficiency of Medicare. NBER Working Paper No. 8395. Cambridge, MA: National Bureau of Economic Research;2001
53 Sepucha KR, Fowler FJ,Jr, Mulley AG,Jr. Policy support for patient-centered care: The need for measurable improvements in decision quality. Health Aff. 2004;Suppl Web Exclusive.VAR54-62
54 Sirovich BE, Gottlieb DJ, Welch HG, Fisher ES. Regional variations in health care intensity and physician perceptions of quality of care. Ann Intern Med. 2006;144:641-649   DOI
55 Skinner, J, Wennberg, JE. How much is enough? Efficiency and Medicare spending in the last six months of life. NBER Working Paper No. 6513. Cambridge, MA: National Bureau of Economic Research;1998
56 Skinner JS, Staiger DO, Fisher ES. Is technological change in medicine always worth it? The case of acute myocardial infarction. Health Aff. 2006;25:w34-47   DOI   ScienceOn
57 Skinner J, Fisher E. Regional disparities in Medicare expenditures: An opportunity for reform. National Tax Journal. 1997;50:413-425
58 Stano M Further issues in small area variations analysis. J Health Polit Policy Law. 1991;16:573-588   DOI
59 Stano M. Evaluating the policy role of the small area variations and physician practice style hypotheses. Health Policy. 1993;24:9-17   DOI   ScienceOn
60 Steinberg EP. Variations research. The physician perspective. Med Care. 1993;31:YS86-8
61 Swinkels IC, Wimmers RH, Groenewegen PP, van den Bosch WJ, Dekker J, van den Ende CH What factors explain the number of physical therapy treatment sessions in patients referred with low back pain; a multilevel analysis. BMC Health Serv Res. 2005;5:74   DOI   ScienceOn
62 The Dartmouth Atlas Working Group. Windows on health care: The faces of variations. Available at: http://www.dartmouthatlas.org/atlases/lecture.shtm. Accessed June 26, 2006
63 Wennberg J, Gittelsohn A. Small area variations in health care delivery. Science. 1973;182:1102-1108   DOI   ScienceOn
64 Verstappen WH, ter Riet G, Dubois WI, Winkens R, Grol RP, van der Weijden T. Variation in test ordering behaviour of GPs: Professional or context-related factors? Fam Pract. 2004;21:387-395   DOI   ScienceOn
65 Wennberg JE, Cooper MM. The quality of medical care in the United States: A report on the Medicare program. The Dartmouth Atlas of Health Care 1999. Chicago, IL: American Hospital Association Press;1999
66 Wennberg J. Wrestling with variation: An interview with Jack Wennberg. Health Aff. 2004;Suppl Web Exclusive.VAR73-80
67 Wennberg JE. Dealing with medical practice variations: A proposal for action. Health Aff. 1984;3:6-32
68 Wennberg JE. Improving the medical decision-making process. Health Aff. 1988;7:99-106   DOI
69 Wennberg JE. Outcomes research, cost containment, and the fear of health care rationing. N Engl J Med. 1990;323:1202-1204   DOI   ScienceOn
70 Wennberg JE. Future directions for small area variations. Med Care. 1993;31:YS75-80
71 Wennberg JE. Unwarranted variations in healthcare delivery: Implications for academic medical centres. BMJ. 2002;325:961-964   DOI
72 Wennberg JE, Barnes BA, Zubkoff M. Professional uncertainty and the problem of supplierinduced demand. Soc Sci Med. 1982;16:811-824   DOI   ScienceOn
73 Wennberg JE, Blowers L, Parker R, Gittelsohn AM. Changes in tonsillectomy rates associated with feedback and review. Pediatrics. 1977;59:821-826
74 Wennberg JE, Freeman JL, Shelton RM, Bubolz TA. Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. N Engl J Med. 1989;321:1168-1173   DOI   ScienceOn
75 Wennberg JE, Bunker JF, Barnes B. The need for assessing the outcome of common medical practices. Annu Rev Public Health. 1980;1:277-295   DOI   ScienceOn
76 Wennberg JE, Fisher ES, Stukel TA, Skinner JS, Sharp SM, Bronner KK. Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States. BMJ. 2004c;328:607   DOI   ScienceOn
77 Wennberg JE, Freeman JL, Clip WJ. Are hospital services rationed in New Haven or over-utilised in Boston? Lancet. 1987;1:1185-1189
78 Westert GP, Groenewegen PP. Medical practice variations: Changing the theoretical approach. Scand J Public Health. 1999;27:173-180
79 Wright JG, Hawker GA, Bombardier C, Croxford R, Dittus RS, Freund DA, et al. Physician enthusiasm as an explanation for area variation in the utilization of knee replacement surgery. Med Care. 1999;37:946-956   DOI   ScienceOn
80 정은경,문옥륜,김창엽. 의사 특성에 따른 외래 진료내용의 변이. 예방의학회지 1993;26(4):614-627
81 Rice N, Jones A. Multilevel models and health economics. Health Econ. 1997;6:561-575   DOI   ScienceOn
82 Schouten JA, Hulscher ME, Kullberg BJ, et al. Understanding variation in quality of antibiotic use for community-acquired pneumonia: Effect of patient, professional and hospital factors. J Antimicrob Chemother. 2005;56:575-582   DOI   ScienceOn
83 Cleary PD, EdgmarrLevitan S. Health care quality. Incorporating consumer perspectives. JAMA. 1997;278:1608-1612   DOI
84 Fisher ES. Medical care-is more always better? N Engl J Med. 2003;349:1665-1667   DOI   ScienceOn
85 The National Library of Medicine. Medical subject headings (MeSH). Available at: http://www.ncbi.nlm.nih.gov.libproxy.lib.unc.edu/entrez/query.fcgi?db=mesh. Accessed July 21, 2006
86 Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458-1465   DOI   ScienceOn
87 Garber AM. To use technology better. Health Aff. 2006;25:w51-3   DOI   ScienceOn
88 Franks P, Williams GC, Zwanziger J, Mooney C, Sorbero M. Why do physicians vary so widely in their referral rates? J Gen Intern Med. 2000;15:163-168   DOI
89 정성원,조영태. 한국적 특수성을 고려한 지역특성과 개인의 건강. 예방의학회지 2005;38(3):259-266   과학기술학회마을
90 이홍기,문옥륜,이기효. 편도적출술 빛 아데노이드제거술과 충수절제술의 지역별 변이. 예방의학회지 1993;26(3):430-441
91 조우현,김한중. 소규모 지역간 의료이용의 차이에 관한 문헌고찰. 보건행정학회지 1991;1(1):44-53
92 Wennberg JE, McPherson K, Caper P. Will payment based on diagnosis-related groups control hospital costs? N Engl J Med. 1984;311:295-300   DOI   ScienceOn
93 Wennberg JE, Fisher ES, Skinner JS. Geography and the debate over Medicare reform. Health Aff. 2004a;Suppl Web Exclusive:W96-114
94 Wennberg JE, Fisher ES, Stukel TA, Sharp SM. Use of Medicare claims data to monitor provider-specific performance among patients with severe chronic illness. Health Aff. 2004b;Suppl Web Exclusive.VAR5-18
95 Verstappen W, ter Riet G, van der Weijden T, Hermsen J, Grol R. Variation in requests for imaging investigations by general practitioners: A multilevel analysis. J Health Serv Res Policy. 2005;10:25-30   DOI   ScienceOn