title: Variation between end-of-life health care costs in Los Angeles and San Diego: why are they so different?
abstract: BACKGROUND
  Small area differences in health care use between Boston, Massachusetts, and New Haven, Connecticut, are well known. However, we do not know whether factors believed to account for these variations explain differences between other geographic areas.
  
  
  OBJECTIVE
  To explore differences in health care use between the California counties of Los Angeles (LA) and San Diego.
  
  
  METHODS
  Medicare data were obtained form the Dartmouth interactive website. In addition, hospital-level data were obtained for the California Office of Statewide Health Planning and Development (OSPHD). Health outcomes and self-reported disease prevalence were estimated from the California Health Interview Survey (CHIS).
  
  
  RESULTS
  Physician supply was comparable between LA and San Diego. Fees per unit service were also equivalent. Hospital beds beds per 10,000 population were 35% higher in LA. Intensity of service use, particularly during the last 2 years of life, was significantly higher in LA, and costs were dramatically higher. Most of the differences were explained by discretionary hospital admissions, end-of-life care, and lower use of hospice care. Quality indicators favor San Diego.
  
  
  CONCLUSIONS
  Medical care, particularly at the end of life, is significantly more expensive in LA than in San Diego, yet quality measures tend to favor in San Diego. Non-emergent hospital admissions and inpatient care at the end of life are important contributors to the cost differences. There is little reason to believe that the greater spending for health care in LA results in better patient outcomes.
authors.affiliation: Department of Health Services, UCLA School of Public Health, Los Angeles, California, USA. rmkaplan@ucla.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kaplan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D019992:Databases as Topic; D018588:Fee-for-Service Plans; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D015141:Los Angeles; D006278:Medicare / Q000191:economics; D010820:Physicians / Q000600:supply & distribution; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D017062:Small-Area Analysis; D013727:Terminal Care / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States