More on geographic variation

from NY Times an essay on Richmond, VA and costs and outcomes there....and the fact that often the highest quality/best outcome areas are not the most expensive. Interesting article from most recent Archives of Internal Medicine on the risks of radiation from overuse of tests as an example of the cultural notion that more is always better is not likely the case in health care. Also, here is a link to the Dartmouth Health Atlas, the group that has popularized the study of small area analysis and geographic variation in health care. Here is a recent paper in the New England Journal of Medicine from some of the Dartmouth folks responding to criticisms about small area analysis and folks saying variations are driven by race on income only....they find these factors account for about 30% of the variation in expenditures across geography, with the remainder driven by system factors (how many docs, type of facilities, etc.). Here is a recent NY Times op-ed arguing that more doctors is not only not needed but would be bad for the system if teaching hospitals allowed to simply goose the existing system.