For patients contemplating elective procedures in California, where they live matters. CHCF research finds rates for certain surgeries and other procedures vary dramatically across the state. Patients in some areas receive surgery, while others with the same condition receive different treatments elsewhere.

This CHCF Sacramento briefing examined the patient impact of overuse and underuse of certain elective procedures and why practice patterns differ; policy implications of this regional variation; and potential solutions. Understanding and addressing this "unwarranted" variation could lead to more effective expenditures of our health care dollars and a healthier California.

Presenters:

• Laurence C. Baker, PhD, professor of Health Research and Policy, Stanford University
• Shannon Brownlee, MS, acting director, Health Policy Program, New America Foundation
• Maryann O'Sullivan, JD, independent health care consultant

Reactor panel:

• Lance Lang, MD, FAAFP, clinical director, California Quality Collaborative, Pacific Business Group on Health
• Benjamin Moulton, JD, MPH, senior legal advisor, Foundation for Informed Medical Decision Making

The CHCF research examines variation rates in hip and knee replacement, coronary artery bypass graft surgery, and elective induction of childbirth, among many other procedures. Only elective procedures were examined, because the rate at which they are delivered is determined by the preferences of clinicians and patients. They were chosen because they are commonly performed, and/or because earlier studies have shown wide geographic variation in those procedure rates across the country.

The briefing included a look at a new feature from CHCF: an interactive map that illustrates regional variation rates of the elected procedures studied, broken down by Hospital Service Area and Hospital Referral Region.

This analysis is based on data from the Medicare population (both fee-for-service and managed care), as well as data on younger individuals enrolled in commercial plans, Medicaid, or who are uninsured. The consistency of results across the under- and over-65 population makes this a significant contribution to the literature documenting regional variation.