Most Medicare data are now adjusted for this factor, and reflect the patient s residence instead of the site of care. Other adjustments also need to be considered, such as wage rates, age, and ideally some indicator of burden of disease . In 1998, the Wisconsin Department of Health and Family Services estimated personal expenditures for the year 1996, using a model based on Medicare, Medicaid, and hospital expenditures. Such an extrapolation is crude, and should be interpreted with caution. For Medicare, more current accurate data are available.
Data are even harder to come by for such questions.
These data are not adjusted for residents who are hospitalized or have ambulatory surgery out of state. There is a slight inverse relationship between a county having high hospital charges and lower ambulatory surgery charges. It would be important to have data on other components of health expenditure such as physician services out of hospital, drugs, nursing homes, etc. In 1997, Wisconsin Act 231 authorized the Department of Health and Family Services to collect data from physician offices and emergency departments. Certainly, similar adjustments listed for states would also need to be considered at the county level to provide a fair basis for comparison.