This policy briefing examined research that attempts to bring together disparate findings on health care variation, to identify regions that appear to be outliers across multiple health care delivery segments in the state, and to further understand how variation patterns are similar or different when looking at different types of care and different payers across hospital referral regions.

The speaker was Dr. Lawrence C. Baker, Stanford University health policy researcher.

Highlights of the presentation were:

• Summarized results of other studies of care variation in California, which was of particular interest in light of the Atul Gawande article on health care utilization differences in McAllen vs. El Paso.
• Quality implications associated with high and low spending are not very clear in California. Though the Dartmouth Atlas team has shown that "more is not better" when caring for most chronic disease patients, recent work with congestive heart failure patients within the UC system shows that in some limited cases more care may lead to lower mortality rates. The difficult part is knowing when more care will matter and when it will not.
• Capacity clearly plays a role in spending patterns. When reviewing MRI capacity, having more MRIs was associated with more MRIs being conducted. CT utilization had similar results.
• The concluding comments that suggested that payment and organizational reform should focus on addressing these questions of variation, and on if and when "more is better." Improved data collection was also identified as a way to help researchers learn more about the issues. The potential need for regulatory controls was also discussed.

The presentation slides are available under Document Downloads. More information on medical care variation is available under Related CHCF Pages.