What Does Dover and Lebanon NH Have to Do With Bangor Maine?

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Not much, but the differences in children’s healthcare care in these communities reveals some important factors concerning quality healthcare and why, for instance, more children in Bangor Maine receive CT scans than children living in Lebanon New Hampshire.
According to a recent post in the Bangor Daily News, “If you grow up near Dover, N.H., you’re three times more likely to have your tonsils removed than a child growing up near Bangor. But a Bangor-area child is 2.5 times more likely than a child in Lebanon, N.H., to receive an abdominal CT scan. Those are among the conclusions of researchers from the Dartmouth Atlas Project in New Hampshire, who examined health insurance claims data for children in Maine, New Hampshire and Vermont to learn about the variability of children’s health care by region. Their analysis confirmed a fact well known in the medical community: Certain routine procedures are more common in particular areas than others. Further, the reason isn’t because of greater medical need in one area than another. A region’s prevailing medical culture — not what the scientific evidence says is best practice — has a greater influence on how often doctors order particular procedures.”
But quantity doesn’t necessarily translate in quality. There are disturbing factors that may affect why in some regions there are more CT scans or tonsillectomies. The editorial from the Daily News offers one reason, “Doctors — particularly specialists — can profit from providing excessive care, especially self-referrals. That’s when the referring physician performs the specialized test, procedure or surgery he or she recommends for his or her patient. And fee-for-service payment systems used by insurers reward health care providers for the quantity rather than quality of care.”
This is something we’ve known for quite some time but there is little attention to fixing this inequity and profiteering in the health industry.

Kevin Dugan
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