How Much Care Children Get Depends on Where They Live

Rates of healthcare use vary greatly from one part of the United States to another, according to a new report for the Dartmouth Atlas Project.

For example, the report found children in Lebanon, NH, are more than twice as likely to have tonsillectomies than those in Bangor, ME, and children in Lewiston, ME, are 50% more likely to have a computed tomography (CT) scan of the head than kids in Portland, ME.

Lead study author David Goodman, MD, of the Geisel School of Medicine at Dartmouth University, said the geographic variation means some children are not getting enough care, while other children are receiving unnecessary care.

While the report focused on northern New England, its findings are similar to previous studies that showed a similar geographic variability among older Americans covered by Medicare.

The report also found regional variations in rates of hospitalizations, common surgeries, imaging, prescriptions, and office visits for well-child visits and middle-ear infections.

The presence of large medical centers, children’s hospitals, and pediatricians and specialists did not matter a great deal when it came to the variations. The number of physicians in an area also did not necessarily increase the rate of questionable procedures, and fewer doctors did not reduce it.

The researchers said the greatest variation was seen in “preference-sensitive” care, such as tube placement in the ears.

“As a result, preference ruled: Middlebury, VT, has more than 4 times the rate of tube insertions as Bangor, ME,” the researchers noted. The rise of the number of CT scans in a few areas raised concerns.