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Health spending more complex than Medicare shows

A medical records clerk in Clinica Sierra Vista's East Bakersfield Community Health Center in Bakersfield, California, October 20, 2009. REUTERS/Phil McCarten

A medical records clerk in Clinica Sierra Vista's East Bakersfield Community Health Center in Bakersfield, California, October 20, 2009.

Credit: Reuters/Phil McCarten

WASHINGTON | Wed Aug 10, 2011 10:42am EDT

WASHINGTON (Reuters) - Communities known for paying the most on healthcare may not be spending as much as once thought, according to new data released on Wednesday.

A Thomson Reuters study, touted as the first of its kind, examined private insurance claims for 23.5 million Americans across the U.S. in 2009. The findings identified "metropolitan statistical areas" throughout the country that spent the most and least on healthcare across demographics.

The study's researchers said the findings challenge the established literature that has traditionally used data from the Medicare program for the elderly to determine geographic spending variations for people of all ages.

The study looked at 382 communities throughout the U.S.

"The real world is actually more complicated than some people might think, and that the patterns you see for the Medicare population aren't exactly the same as the patterns you see for adults or children in the same areas," said William Marder, the study's lead author.

As Congress considers how to further cut federal spending ahead of a November deadline, including spiraling healthcare costs, the study shows that there may be better ways to project how healthcare cuts affect a community.

It highlighted McAllen, Texas, a community known for having the highest Medicare spending in the U.S. However, the new research puts McAllen on the list of the ten cheapest areas for individuals with employer-sponsored health insurance.

"What we're looking at here is that McAllen, Texas is actually a pretty cheap place when you start looking at people under age 65," said Marder. He added that the findings should give policymakers pause before they change the healthcare system of the area without understanding the spending system more deeply.

The study did not examine the causes behind McAllen's spending disparity. Previous studies by the Dartmouth Atlas project on healthcare have attributed its high spending to McAllen doctors performing more tests and diagnostics than in similar towns.

The Thomson Reuters study also looked at spending patterns. Researchers found that spending depended on age and the type of procedure. Marder attributed the spending variations to a community's use of services, like doctor's visits and hospital stays.

In general, the research identified Ogden and Clearfield, Utah as the area spending the least on healthcare for the commercially insured at $2,623 per person. Anderson, Indiana was the most expensive area at $7,231 per person.

(Reporting by Andrew Seaman; Editing by Bernard Orr)

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Comments (5)
Joecynic wrote:
After an experience of being in the hospital for procedures that did not need hospitalization, I believe Medicare is being used to fatten the health care system. Medicare should list what it will not pay for hospitalization when other means are available.

Doctors are quite aware of the funds Medicare will pay.

Aug 10, 2011 5:49am EDT  --  Report as abuse
ComnSents wrote:
“new research puts McAllen on the list of the ten cheapest areas”

I am continually amazed at how much “research” and “polls” move people’s actions and thoughts. I am equally amazed at the continued garbage that is published under the auspices of the word “research.” The fact that this study needed to demonstrate to readers that prior studies may not be accurate is testament to the complexity of Medicare, health care and the entire healthcare system. And as the reader “Joecynic” suggests: “Doctors are quite aware of the funds Medicare will pay.” We are also quite aware of the funds that Medicare does NOT pay. We are also quite aware of the DECREASING funds that Medicare does and does NOT pay. We are also quite aware that studies that purport to demonstrate how expensive Medicare is for a given community serve only to highlight the failings of the system, not the community.

Reason shall prevail. It’s just a matter of time. Government financing of the nation’s health is not practical, as evidenced by the Medicare/Medicaid experiment. National health care…you’ve got to be kidding.

Aug 10, 2011 10:52am EDT  --  Report as abuse
jrj90620 wrote:
Anyone notice that inflation in higher education and healthcare is much higher than in other businesses?That is because much of the spending is covered by third parties.The person receiving the education or healthcare doesn’t care what the providers charge for their services,just what they pay.What we need is for the consumer to pay more of what is being charged.At least 50% of what is charged.That would end the practice of hospitals billing thousands of Dollars per hour for minor care,because few could afford it.Colleges would lose their customers if they continued charging more than the student could afford.This socialization of costs is allowing these providers to massively overcharge.When I am charged $3,000-$5,000 per hour for minor care,I have to fight hospitals and doctors,who are accustomed to overcharging,because of our 3rd party payer system.I end up getting bill collectors phone calls.Eventually,they give up,when they find out I won’t pay thousands of Dollars an hour for minor procedures.I’ve even been billed for items never received.They don’t care.I need more of you to join me and refuse to pay excessive health insurance prices,which are high because of providers overcharging.If more of you paid the cost,you would be like me and not allow them to cheat.So,in conclusion,we need less insurance coverage,not more.Less student loans.

Aug 10, 2011 11:32am EDT  --  Report as abuse
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