The Dartmouth Atlas is a hugely influential force in health policy, showing that a patients' treatment can, in many cases, depend more on where they live than what's actually wrong with them.


Their new report out today shows that to be true with prescriptions: There's huge variation in how many drugs doctors prescribe, only one-third of which can be explained by differences in health status. 

"The average beneficiary in Miami, Florida filled about 63 prescriptions in 2010, while the average beneficiary in Grand Junction, Colorado filled just 39 prescriptions," the researchers find.

Some of this is explained by the fact that certain seniors are in worse health and would therefore need more treatment. And that is true, but not the entire story: Accounting for age, gender and co-morbid conditions, researchers say that only about 31 percent of the variation in drug prescriptions among Medicare Part D enrollees is explained by how sick they are.

Variation shows up when you look at specific conditions, like how doctors prescribe drugs after a heart attack. The National Committee for Quality Assurance, which issues evidence-based standards for patient care, recommends that heart attack patients be kept on a type of drug called a beta-blocker for six months after discharge.

In some places, 92 percent of hospitals achieve this metric. In others, fewer than 68 percent hit the quality standard.


Similar variation shows up for diabetes patients and those who have a fracture due to fragile bones, indicating that these big differences aren't specific to any condition, but pretty much pervasive throughout the health-care industry.