"...the medical culture of an area influences how doctors practice medicine"

By John Ballard

Same message. Different language.
I know this is tiresome, but repetition is a good way to drive home a point.

For background, anyone who has yet to read Dr. Gawande's June article in The New Yorker should do so at once. The Cost Conundrum is to health care reform what Uncle Tom's Cabin was to the Civil War.
Do it now. This post can wait. It will underscore the point of this post better than anything I can say.

The following snips are an excellent appendix to any close examination of America's health care crisis. Maggie Mahar posts new map which examines rural and exurban areas showing great variations in Medicare expenditures all over the country.

Why is Health Care So Expensive in Rural Louisiana?

The map and the post are based on data collected by researchers at the Dartmouth Medical School. Doctors and economists there take a sample of Medicare costs from some 1,843 hospital service areas where a majority of the people are living in rural or exurban zip codes.
The green areas on the map denote hospital service areas that spent below the nation of average of $8,176 per patient (averaged from 2004 to 2006) for Medicare patients. The brown areas spent above the national average. The white areas represent urban hospital service areas, and in a few cases, areas with no data.

[...]this new map shows that the differences among rural areas are as great as the cost variations from one metro region to another. Moreover, the high cost rural service areas are generally in the same places where there were cities with high Medicare costs. This suggests that that the medical culture of an area influences how doctors practice medicine.

?when physicians own hospitals, they are more likely to send their patients to them for tests and treatments.

?Physicians also tend to refer healthier patients to their own clinics, while sending sicker patients to community hospitals. While physician-owned hospitals claim that they provide better care, �peer-reviewed research finds that lower unadjusted mortality rates in cardiac specialty hospitals are largely attributable to the fact that these facilities admit healthier patients,� the Health Affairs study notes. �After adjusting for procedural volume and patient characteristics, mortality rates and outcomes were similar.�

?Finally, even though the patients are healthier, the Medicare Payment Advisory Commission reports that care at specialty hospitals owned by doctors tends to be more expensive.

Am I wrong in seeing a conflict of interest when physicians profit from two separate sources?
It's what my Dad called "double dipping."