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The Dartmouth Atlas of Health Care 1996

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Health services researchers have established that there exist large variations in the use of medical care among communities and regions across the United States. The care an individual receives depends in large part on where he or she lives, the supply of resources available in that place, and the practice patterns of local physicians. The 1996 Dartmouth Atlas of Health Care highlights these variations and is the first of its kind. Developed by researchers at the Center for the Evaluative Clinical Sciences at Dartmouth Medical School, the Atlas begins by establishing the geographic boundaries of naturally occurring health care markets in the United States. One important finding was that hospital service areas and hospital referral regions correspond poorly to political configurations, such as counties, which have traditionally been used to measure health care resources and utilization. The Atlas is also a reference tool that focuses on the acute care hospital capacity in each hospital referral region and provides a framework for understanding the implications of geographic variations in hospital resources, the utilization and costs of care, and the impact of these variations for population mortality. It reports on federal spending for the Medicare program in each of the 306 hospital referral regions during 1993 and provides detailed information about the geographic distribution of the physician workforce that year. Findings document wide variation in the use of diagnostic and surgical procedures for people with coronary artery disease, prostate cancer, breast cancer, and back pain. Based on the data, the Atlas estimates the number of hospital beds, personnel, and expenditures that could be reallocated to another use if the rates of more efficient regions became the standard of practice. It also provides detailed information about each hospital referral region.