Drug use, spending varies widely in U.S. by region

As the government searches for ways to limit Medicare spending, it may eye a new report that says in some regions, older patients don't get the drugs they need--and others are getting drugs that can be dangerous to their health. Prescription drug use among Medicare patients and spending by region is wildly inconsistent, it says, and in some cases, the health status of patients in the region has little to do with it.

Preventative therapies and the use of costly, tried-and-true treatments can easily drive up drug spending. But according to Dartmouth Atlas, a project focused on assessing the efficiency of the nation's healthcare system, that's not what's going on in many regions. Researchers found that the health status of a region's Medicare population accounts for less than a third of the disparity in spending, prompting questions about how much impact regional practice culture has on the quality and quantity of prescriptions written.

"There is no good reason why heart attack victims living in Ogden, Utah, are twice as likely to receive medicine to lower their cholesterol and their risk of another heart attack than those in Abilene, Texas, but this inconsistency reflects the current practice of medicine in the United States," lead author Jeffrey Munson of The Dartmouth Institute for Health Policy & Clinical Practice said in a statement.

His team's report examines prescription drug use among Medicare Part D beneficiaries, who totaled 37 million in 2012. Researchers divided the country into 36 regional healthcare markets, drawing comparisons between the regions' use of drugs proven effective for treating certain conditions. They found that doctors in high-spending areas did not necessarily prescribe widely recommended treatments to their patients; for example, the use of beta blockers and statins following a heart attack, or the use of osteoporosis meds after a bone fracture. And failure to prescribe those treatments can hurt both drugmakers and the government; where pharma companies miss out on revenue potential, the country's healthcare system may be forced to pick up hospitalization or procedure costs down the line if conditions go unaddressed.

And on top of that, many doctors prescribe drugs deemed potentially harmful for patients over 65, the Dartmouth study found. More than one out of every four Medicare Part D beneficiaries--26.6%--filled at least one script in 2010 for a med tabbed as dangerous for seniors, including skeletal muscle relaxants and highly sedating antihistamines. Those results follow data published in April in The Journal of General Internal Medicine that showed use of these drugs in the elderly is more common in the South; according to the Dartmouth research, 14.6% of Medicare patients in Alexandria, LA, filled prescriptions for two or more of the drugs on the "risky" list in 2010.

"Instead of varying widely, patterns of care should be nearly uniform across the country for non-controversial drug therapies with a strong evidence for their use," longtime Dartmouth Atlas funder Katherine Hempstead said in a statement. "This report demonstrates how far we still have to go as a nation to make sure people get the care they need when they need it."

- read the release
- see the full report (PDF)

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