Tag Archives: dartmouth atlas

Med school prof: Dartmouth Atlas is ‘malarkey’

In a story done in collaboration with The Philadelphia Inquirer, Kaiser Health News’ Jordan Rau’s report on a leading physician’s provocative attack on the Dartmouth Atlas gets off to a lively start:

As he raced through the U.S. Capitol this fall, Dr. Richard “Buz” Cooper, a 73-year-old University of Pennsylvania medical school professor, didn’t mince words. He denounced as “malarkey” a reigning premise of the health care debate – that one-third of the nation’s $2.5 trillion in annual health spending is unnecessary – and said that the idea came from “a bunch of clowns.”

Digging beyond these inflammatory comments, Rau finds that Cooper’s argument revolves around one idea: That the research “doesn’t take into account the high cost of helping the impoverished, who often spend more time in hospitals because they don’t have people to care for them at home and often return to the hospital when they can’t afford needed medications.”

Meanwhile, the Atlas folks’ response has been as blunt as Cooper’s attacks. They say the Penn researcher is wrong and doesn’t adequately understand Dartmouth’s statistical controls.

“It’s impossible to carry on a debate with somebody who does not understand statistics, and seems uninterested in learning,” Jonathan Skinner, a senior author of the Atlas, says of Cooper.

Most experts seem to be lining up on the Dartmouth side of the dispute, and Rau digs past the “clowns” and “malarkey” and helps readers understand the validity of Cooper’s criticism and the Atlas.


To learn more about the Dartmouth Atlas and how to use it to determine how medical resources are distributed and used in the United States, read AHCJ’s Covering Hospitals, a slim guide that focuses on how journalists can best use Dartmouth Atlas and Hospital Compare.

Rural health costs: Lower, but just as uneven

Writing on the rural news site Daily Yonder, Bill Bishop and Julie Ardery take a look at the Dartmouth Atlas, using only cost data from the two-thirds of hospital service areas that have mostly rural or exurban populations. They found that only 27 percent of the rural HSAs had Medicare reimbursement costs above the national average, but that variations in spending between rural areas were just as pronounced as those among their urban counterparts.

Bonners Ferry, Idaho, a town of about 2,500 near the Canadian border that’s home to the lowest Medicare costs of any American majority-rural area. Photo by prentz via Flickr.

The accompanying map is particularly nifty, not just because of what it shows about rural health differences, but also about the coverage and costs of rural hospitals.

To learn more about the Dartmouth Atlas and how to use it to determine how medical resources are distributed and used in the United States, read AHCJ’s Covering Hospitals, a slim guide that focuses on how journalists can best use Dartmouth Atlas and Hospital Compare.


How hysterectomies spurred Dartmouth Atlas’ birth

In the first of a three-part series on health care costs in America, NPR’s Alix Spiegel tells the story of the birth of the Dartmouth Atlas, how some of its founder’s earliest research changed the health care delivery system in Maine and what it tells us about health and money. Spiegel unspools the story as a series of questions, the answer to each of which pushed researchers and physicians closer to an understanding of what drives health care costs in America.

The story kicks off in the mid ’60s when John Wennberg, now famous (among health reporters, at least) as the father of the Dartmouth Atlas, got a grant to study the best way to expand health technology to rural Vermont. To answer that question, Wennberg asked what health care was actually delivered in the state. From there, he discovers massive geographical differences in the frequency of procedures such as hysterectomies, and the questions and answers tumble neatly into line like so many dominoes.

Part two of the series, focusing on how active patient participation drives up costs, will air next week on NPR’s Morning Edition. In the third installment, Spiegel will examine the cost impact of direct-to-consumer advertising of prescription drugs.

Project looks at high price of health care in Dallas

In their “The Cost of Care” package, Dallas Morning News reporters seek to explain why, as Jim Landers says in the lead of a key story, one of the nation’s largest cities is “broken market where doctors, hospitals and other providers shower patients with services of diminishing value but staggering cost.”

The problems are clear: The Dartmouth Atlas ranks Dallas as the 13th priciest health market in the nation, while new Census data gives Texans the dubious honor of living in the least-insured state in the nation. The whys and hows of these issues are trickier, but the Morning News wades into the health spending morass.

Dallas sees no relief in health care expenses as competition drives up costs

Jim Landers explores the paradox that health care in the city is expensive because there’s so much competition, and considers the contributions marketing and medical records make to health care costs. The piece includes an interesting profile of CIGNA regional president David Toomey’s attempts to rein in costs in the area.

‘Vicious circle’ of uninsured results in higher bills for health coverage, taxes in Dallas-Fort Worth

Robert Garrett and Jason Roberson explain how everybody pays the price for the area’s super-low insurance coverage rates, and put an exact cost estimate, both financial and human, on the price of a high uninsured population.

Doctor-owned hospitals a lucrative practice, though opinions split on benefits

Gary Jacobson’s weighs the costs and benefits, both economic and medical, of doctor-owned hospitals, which are more common in Dallas than any other major metropolitan area.

Medical imaging a growth industry, but some say unneeded scans increase expenses

Ryan McNeill assesses just how useful the high-speed, unregulated growth of medical imaging has been for patients, doctors, investors and other stakeholders.

Critics see home health care boom as wasteful, but others tout benefits

When you’re looking to explain growing costs, it makes sense to focus your efforts on growing sectors, and Gregg Jones does just that, looking at the fast-growing home health sector. He leads with Medicare fraud, but then shows just how much deeper and more complicated the cost equation of home health care can get.

Primer on reform draws from AHCJ presentation

Sarasota Health News reporter and editor David Gulliver released his own evaluation of health care reform, drawing on the Dartmouth Atlas and the speech Princeton economist Uwe Reinhardt delivered in “brilliant – and, believe it or not, hysterically funny – style at the Association for Health Care Journalists national conference in April.”

Uwe Reinhardt

Uwe Reinhardt

After sketching a clear and convincing portrait of a failing system, Gulliver takes his assessment even further, venturing authoritative predictions on what a final health care reform package will look like. Gulliver goes into some detail, with the general idea being that the final product will include a universal insurance mandate, a public option that would only go into effect if that mandate’s goals were not met and increased regulation of the insurance industry. Gulliver’s straightforward, un-muddled approach makes the piece both accessible to a broad audience and interesting even to those who read and write about health for a living.

Find a copy of Reinhardt’s Health Journalism 2009 presentation here.