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For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide comprehensive information and analysis about national, regional, and local markets, as well as individual hospitals and their affiliated physicians.
These reports, used by policymakers, the media, health care analysts and others, have radically changed our understanding of the efficiency and effectiveness of our health care system. This valuable data forms the foundation for many of the ongoing efforts to improve health and health systems across America.
This website provides access to all Atlas reports and publications, as well as interactive tools to allow visitors to view specific regions and perform their own comparisons and analyses.
Further studies and data created with the support of the National Institute on Aging can be found here. The goal of one study was to develop an instrument and conduct a survey of Medicare beneficiaries, and to better understand the causes and consequences of geographic variation in per capita expenditures for Medicare beneficiaries.
More Physician Training and Health Care Reform? In a New York Times Op-Ed piece, Shannon Brownlee and David Goodman explain that the seemingly simple solution of adding more physicians to improve health care is more likely to further fragment care and drive up costs. Under the guise of training more primary care physicians, proposed amendments to health care reform legislation would end up accelerating the growth of specialty care and would add physicians to the cities that already have very high supply.
Ms. Shannon is a fellow of the New American Foundation and author of "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer." Dr. Goodman is a Professor of Pediatrics at the Dartmouth Insitute for Health Policy and Clinical Practice, Director of the Center for Health Policy Research, and the Co-Principal Investigator of the Dartmouth Atlas of Healthcare.
New Study Underscores Importance of Regional Variations in Spending: An article by Jason Sutherland, Elliott Fisher and Jonathan Skinner, published in the New England Journal of Medicine in September 2009, examines the key role of regional factors in explaining variations in health care spending. Some critics of the Dartmouth work have asserted that individual health and socioeconomic status explain most of the variation across U.S. regions. The New England Journal article by the Dartmouth faculty uses data from a national survey of Medicare beneficiaries to show that individual health status is a major determinant of spending; beneficiaries in excellent health spend an average of $3,469 per year, while those in poor health spend six times as much ($21,064). Similarly, low income Medicare enrollees spend more than high income enrollees. However, these factors combined could not explain away the wide regional variations in health care expenditures. Specifically, the authors found that just 30% of the excess spending in the highest-cost regions could be attributable to income and health, leaving the vast majority of expenditures due to regional factors. The findings reinforce the longstanding Atlas conclusions that the variations in spending across regions and hospitals provide evidence of important opportunities to reduce the costs of U.S. health care.
Taming Wide Variations in Spending Key to Health Reform-New England Journal of Medicine Commentary from Dartmouth Atlas Project.
 Huge inefficiencies in the U.S. health care system are hamstringing the nation's ability to expand access to care, according to a new analysis of Medicare spending by researchers of the Dartmouth Atlas Project, published February 26, 2009 in the New England Journal of Medicine. Many experts have blamed the growth in spending on advances in medical technology. But the differences in growth rates across regions show that advancing technology is only part of the explanation. Patients in high-cost regions have access to the same technology as those in low-cost regions, and those in low-cost regions are not deprived of needed care. On the contrary, the researchers note that care is often better in low-cost areas. The authors argue that the differences in growth are largely due to discretionary decisions by physicians that are influenced by the local availability of hospital beds, imaging centers and other resources-and a payment system that rewards growth and higher utilization.
Linking Workforce Policy to Health Care Reform: Dr. David Goodman gave invited testimony at the United States Senate Committee on Finance Hearing on "Workforce Issues in Health Care Reform: Assessing the Present and Preparing for the Future" on March 12, 2009. Dr. Goodman advanced the idea of a permanent health workforce commission to craft evidence-based policy that improves access to care, health outcomes and the quality and affordability of care. Read testimony
Payment Reform Can Promote High-Quality Care and Reduce Medicare Spending Growth.
Medicare could save money and improve health care quality by providing financial incentives to providers for coordinating patient care through a shared savings program, according to a new paper from the Dartmouth Institute for Health Policy and Clinical Practice and the Engelberg Center for Health Care Reform at the Brookings Institution. Research by Elliott Fisher, Mark McClellan, and colleagues demonstrates that such a program, implemented with the establishment of Accountable Care Organizations (ACOs), would benefit patients, payers, and providers. The ACO shared savings concept would eliminate waste, reduce overuse and misuse of care, and support the development of health systems that can deliver high quality, affordable care.
To read the paper, click here. Press release
Expanding Coverage Without Increasing Health Care Spending: Dartmouth Institute White Paper Recommends Course for the Obama Administration.
A new Dartmouth Atlas white paper makes the case that the United States can extend coverage to the country's uninsured without substantially increasing overall health care costs. The paper argues that the incoming Obama Administration and the Congress can adopt measures that will improve health care quality and patient outcomes, while reducing the growth of health care spending. To download An Agenda for Change: Improving Quality and Curbing Health Care Spending: Opportunities for the Congress and the Obama Administration click here. Press release
The Dartmouth Atlas responds
The Dartmouth research group was invited by Health Affairs to respond to a series of articles by Richard Cooper in a December 2008 web release. A summary of the Dartmouth rebuttal is available here.
Tracking the Care of Patients with Severe Chronic Illness: The Dartmouth Atlas of Health Care 2008 is available!
This edition of the Dartmouth Atlas of Health Care describes how care for Medicare beneficiaries with serious chronic illness varies across U.S. states, regions and hospitals. The focus is on Medicare beneficiaries who have severe chronic illnesses and are in their last two years of life. The 2008 edition both updates earlier analyses to encompass more recent data and expands the scope to include all sectors of care covered by the Medicare program: acute inpatient hospital care, outpatient services, skilled nursing and long-term hospital care, home health care and hospice.
You may purchase a copy; download the report, Executive Summary, or press release; use the interactive data tools; and download hospital performance reports by state.
Data from this edition of the Atlas are featured in Consumer Reports' online hospital rating tool.
Find your data
Use the links in the Atlas Data Tools menu at left to find state, region, and hospital-specific data. Download prepared tables from our Download page, or make your own tables and graphs using the Data Tools. Descriptions of the tools and step-by-step Help files can be found on the Data Tools page.
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