Dartmouth vs. Dartmouth

The infamous Dartmouth Atlas publishes maps that purport to report an association between increased Medicare spending and the wasteful overuse of supply sensitive services (top figure, below). But Brown and O’Connor, from the same research unit at Dartmouth, have published a very similar map, which they interpret as showing an association between increased deaths from heart disease and socioeconomic factors (bottom figure). So which is it: more deaths (and therefore more health care spending) due to socioeconomic factors, or more spending in many of the same areas because of the avarice of physicians?

I know that the Dartmouth Atlas crowd won’t listen to reason from me. They even had the audacity to say that almost none of the variation in their Medicare map is due to poverty (shame on them!). But I hope they will listen to their colleagues, Jeremiah Brown and Gerald O’Connor, whose June 10th paper in the NEJM gets it right. People are sicker where they are poorer, and it costs more to care for them.

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