"It makes them look better because they're spending less," he said.
That's not the full story, however. Looking at how New Yorkers use healthcare, the picture changes. "If you look at hospital days near the end of life, and doctors visits in New York, they're still really, really high," Skinner said. "And here's another paradox, when people are admitted to a hospital with a given DRG (diagnostic related group) in New York, they stay in the hospital longer and they're seen by more doctors."
According to an executive summary on the new calculations, in general urban regions tended to exhibit lower spending rates after price adjustment, while rural regions exhibited higher spending.
In addition to downward spending adjustments for New York and San Francisco, expenditures were somewhat higher for certain rural regions such as Bismarck, ND; Jackson, MS and Monroe, LA.
Expenditures still varied greatly across the country per capita, from less than $7,000 per beneficiary in 18 hospital referral regions – including Rapid City, SD ($6,264); Honolulu ($6,653); San Mateo County, CA ($6,723) and Portland, OR ($6,971) to more than $12,000 per beneficiary in Miami ($15,571); McAllen, TX ($14,529); Harlingen, TX ($12,231) and Monroe, LA, ($12,027), the summary said.
Skinner said the Dartmouth team is working on correcting another aspect of its earlier published data, namely that it did not risk adjust for disease status in various parts of the country, because some areas are known to have greater percentage of people affected by obesity, diabetes, hypertension and cardiovascular disease.