Imagine two retirees, both in Florida, both with similar lifestyles and health conditions. The only difference: one lives in Miami, the other in Tampa.

      Chances are, the federal government spends nearly twice as much on the Miami retiree as the Tampa one.

      Those are among the findings of a project called the Dartmouth Atlas, an ongoing examination of differences in health care spending around the U.S. On Friday, Jonathan Skinner, senior author of the Dartmouth Atlas John Sloan Dickey Third Century Chair of Economics at Dartmouth College, discussed those differences at a talk presented by the USF College of Public Health.

     Health economist Jonathan Skinner, PhD, chats with Donna Petersen, ScD, MHS, dean of the College of Public Health

       The nation’s most expensive Medicare patients are in Miami, where Medicare spends $16,351 per enrollee each year. Compare that to Tampa, where spending is $8,911 per enrollee.

      Those cost differences mount up, Dr. Skinner said.

      “You start ending up with enough money for, if not a new Ferrari, at least a used Ferrari,” he joked.

      The cost differences are particularly puzzling when you look at health quality measures , Dr. Skinner said. For example, Medicare spends far less per enrollee in San Francisco than in Miami.

     “Yet by all measures,” he said, “San Francisco is at least as good as Miami.”

      Those differences have important policy implications, Dr. Skinner said – both for reining in Medicare’s spiraling costs and for health care reform. What if we could deliver the same quality of care across the country on a San Francisco budget instead of a Miami one?

      “Could we get closer to universal coverage?” he asked.

      Dartmouth Atlas researchers have tried to find non-medical ways to explain the cost disparities. But possible differences in patients in different cities don’t seem to explain the gaps, Dr. Skinner said. Researchers have adjusted for differences in age, sex, race and income without explaining the disparities.

      What does have an effect? In some places, what Dr. Skinner describes as “entrepreneurial surgeons” – doctors who are aggressive adovocates for a particular procedure – can affect costs. Cardiologists in Elyria, Ohio, for instance, attracted national publicity after Dartmouth Atlas research showed that residents there were getting angioplasties at four times the national average.

      Similarly, another factor that explains regional differences is the amount of money each region spends on health care during the last two years of life — how chronically ill patients are treated and how often they’re hospitalized.  Small differences in how doctors make decisions about whether to send a patient to a hospital or a specialist can add up to big changes in spending.

– Story by Lisa Greene, photos by Eric Younghans, USF Health Communications