Those variations of care are "still a persistent problem, definitely," Wennberg says. "If you do the same measurement we did then," he says of previous reports, "you hit the same story. For most things, they vary and vary idiosyncratically. One region will be high on this end, and will be low on another, when you are talking about surgery anyway."
Wennberg has consistently been putting his footprint on the wide swath of healthcare spending since the early Vermont study. In 1988, Wennberg started the Dartmouth Institute for Health Policy and Clinical Practice, which has been the driver of the research and studies. It was then called the Center for Evaluative Clinical Sciences at Dartmouth Medical School. After stepping down several years ago from running the institute on a daily basis, Wennberg continues his passion to study the foibles of healthcare delivery. He is the Peggy Y. Thomson Professor Emeritus in the evaluative clinical sciences.
Wennberg is also founding editor of The Dartmouth Atlas of Health Care, which examines patterns of medical resource intensity and utilization in the United States. The Atlas project has reported on patterns in end-of-life care, inadequate use of preventive care, and Medicare reimbursement failings.
Wennberg and his colleagues discovered that patients in high-spending areas would see 10 or more specialists during their final six months of life. And yet, chronically ill patients who receive the most intensive, aggressive, and expensive treatment fared no better than those who receive more conservative care.