When one looks at total medical expenditures by state and at the average per patient cost of medical services in the two often cited states, Colorado and Florida, one reaches an entirely different conclusion than the Dartmouth Health study.
For example in 2006, according to the Meps (Medical Expenditure Panel Survey), the average medical expenditure (including Medicare, private health insurance, out of pocket, uninsured, etc.) by all patients in 2006 in Colorado was $3,585. It was $3,586 for Florida. The Dartmouth Health study, which only looks at Medicare, finds that Miami is $16,351 per patient and Grand Junction, Colorado is $5,873.
The Dartmouth study seems to be in part an artifact of Medicare reimbursement policies. There are other federal funding programs to medical providers, e.g., Rural Health Grants and others, etc., and these vary in per capita amount for each state according to federal law and formulas. Dartmouth only looks at Medicare expenditures and does not include other federal medical reimbursement and funding programs. It does not look at total state medical expenditures.
Complex and strict rules limit what can be included in Medicare reimbursement, but as a general rule, double billing is prohibited. The differences that Dartmouth sees could be that some states get less non-Medicare funding and bill a higher share of costs through to Medicare. Other states bill the federal government for part of the same costs under different federal programs. While Medicare expenditures look higher per procedure in some states than other states, the total costs of the two procedures could be identical. It could all be due to reimbursement laws and rules.
The link to the Meps data is:
http://www.meps.ahrq.gov/mepsweb/data_stats/summ_tables/hc/state_expend/2006/table1.htm
The link to the main Meps data page on state medical expenditures is:
http://www.meps.ahrq.gov/mepsweb/data_stats/quick_tables_results.jsp?component=1&searchText=&tableSeries=8&year=-1
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