title: Acute hospital care is the chief driver of regional spending variation in Medicare patients with advanced cancer.
abstract: The root causes of regional variation in medical spending are poorly understood and vary by clinical condition. To identify drivers of regional spending variation for Medicare patients with advanced cancer, we used linked Surveillance, Epidemiology, and End Results program (SEER)-Medicare data from the period 2004-10. We broke down Medicare spending into thirteen cancer-relevant service categories. We then calculated the contribution of each category to spending and regional spending variation. Acute hospital care was the largest component of spending and the chief driver of regional spending variation, accounting for 48 percent of spending and 67 percent of variation. In contrast, chemotherapy accounted for 16 percent of spending and 10 percent of variation. Hospice care constituted 5 percent of spending. However, variation in hospice spending was fully offset by opposing variation in other categories. Our analysis suggests that the strategy with the greatest potential to improve the value of care for patients with advanced cancer is to reduce reliance on acute hospital care for this patient population.
authors.affiliation: Gabriel A. Brooks (gabriel_brooks@dfci.harvard.edu) is an instructor in medicine at Harvard Medical School and a research scientist at the Dana-Farber Cancer Institute, in Boston, Massachusetts.
authors.forename: Gabriel A
authors.initials: GA
authors.lastname: Brooks
authors.affiliation: Ling Li is a data analyst and statistician at the Dana-Farber Cancer Institute.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: Hajime Uno is an assistant professor of biostatistics at the Harvard School of Public Health and a research scientist at the Dana-Farber Cancer Institute.
authors.forename: Hajime
authors.initials: H
authors.lastname: Uno
authors.affiliation: Michael J. Hassett is an assistant professor of medicine at Harvard Medical School and a research scientist at the Dana-Farber Cancer Institute.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hassett
authors.affiliation: Bruce E. Landon is an associate professor in the Department of Health Care Policy at Harvard Medical School.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.affiliation: Deborah Schrag is a professor of medicine at Harvard Medical School and a research scientist at the Dana-Farber Cancer Institute.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
mesh_terms: D005102:Health Expenditures / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D009369:Neoplasms / Q000191:economics*; D014481:United States
keywords: Chronic Care; Health Spending; Medicare; Organization and Delivery of Care; Variations