Regional Variations in Health Care Intensity and Physicians' Perceptions of Care Quality
Authors: Brenda Sirovich, Elliott S. Fisher
Journal: Annals of Internal Medicine (2006)

Letters21 November 2006Regional Variations in Health Care Intensity and Physicians' Perceptions of Care QualityBrenda Sirovich, MD, MS and Elliott S. Fisher, MD, MPHBrenda Sirovich, MD, MSFrom the Department of Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth Medical School, Hanover, New Hampshire.Search for more papers by this author and Elliott S. Fisher, MD, MPHFrom the Department of Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth Medical School, Hanover, New Hampshire.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-145-10-200611210-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: We appreciate Dr. Peirce's ad hoc analysis of our data, showing that relatively higher concentrations of generalists in an area are associated with lower per capita Medicare spending. Before addressing the principle (with which we agree), it is necessary to make an important clarification to his finding. Although it is true that spending falls steadily as the percentage of generalists (family practitioners and general internists) rises from 26% (in quintile 5) to 31% (in quintile 1), a quick glance at our Table 1 shows that this observation does not apply equally to all generalist physicians. In fact, spending ...References1. Sirovich BE, Gottlieb DJ, Welch HG, Fisher ES. Variation in the tendency of primary care physicians to intervene. Arch Intern Med. 2005;165:2252-6. [PMID: 16246991] CrossrefMedlineGoogle Scholar2. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138:288-98. [PMID: 12585826] LinkGoogle Scholar3. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138:273-87. [PMID: 12585825] LinkGoogle Scholar4. Cooper RA, Getzen TE, McKee HJ, Laud P. Economic and demographic trends signal an impending physician shortage. Health Aff (Millwood). 2002;21:140-54. [PMID: 11900066] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From the Department of Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth Medical School, Hanover, New Hampshire.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care Elliott S. Fisher , David E. Wennberg , Thrse A. Stukel , Daniel J. Gottlieb , F. L. Lucas , and Étoile L. Pinder The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care Elliott S. Fisher , David E. Wennberg , Thrse A. Stukel , Daniel J. Gottlieb , F. L. Lucas , and Étoile L. Pinder Regional Variations in Health Care Intensity and Physician Perceptions of Quality of Care Brenda E. Sirovich , Daniel J. Gottlieb , H. Gilbert Welch , and Elliott S. Fisher Regional Variations in Health Care Intensity and Physicians' Perceptions of Care Quality John C. Peirce Metrics Cited byExact and approximate probability distributions of evidence-based bundle composite compliance measuresPerformance of composite versus all-or-none compliance statistics for medical evidence-based core measure sets 21 November 2006Volume 145, Issue 10Page: 789KeywordsChild healthConflicts of interestFallsFearGeographic areasHealth careHealth care qualityMedicarePediatricsPerception ePublished: 21 November 2006 Issue Published: 21 November 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...