The Geography of Healthcare

For more than twenty years, the Dartmouth Atlas of Healthcare has shown variation associated with the costs and quality of healthcare across geographic areas of the United States. Some areas are much more costly than other areas, and there is little evidence that high-cost areas provide better quality of care. Indeed, high-cost regions seem to provide lower quality care. The reasons for this variation are complex, but evidence is growing to support the hypothesis that specialist-driven medicine leads to fragmented and uncoordinated care. Moreover, many medical conditions and treatments are not guided by scientific evidence, and practicing physicians often do not adhere to guidelines when they are available. A popular article in the New Yorker by Atul Gawande is based on some of this research.

Managing the finance of healthcare is important for increasing access to healthcare for uninsured Americans, yet high costs and variable levels of quality must be addressed before any sustainable solution will be reached. In my opinion there is a strong need to transform the culture of medicine that is currently based on physician autonomy to a system in which medical providers work as a team to provide patient-centered care. The Internet may be the force that will empower patients to learn more about their own health, and then motivate them to work together with their providers to achieve the best outcomes possible. Once patients have more information about their health, and are better able to understand risks and benefits of their options, it is likely that they will select less costly treatments that lead to higher quality outcomes. It is likely that once physicians embrace these changes, they will enjoy working with patients who have the capacity to understand more about complex health issues.