Geographic Variation in Health Care Spending

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Abstract:

Per capita health care spending and patterns of medical practice vary widely across the
United States. In this paper, written at the request of the Chairman of the Senate Budget
Committee, the Congressional Budget Office (CBO) examines the amount of geographic
variation in spending, the reasons for that variation, and its implications for evaluating the
efficiency of the health care system. In keeping with CBO’s mandate to provide objective,
impartial analysis, the paper makes no policy recommendations.
David Auerbach and Chapin White of CBO’s Health and Human Resources division prepared
the report under the supervision of James Baumgardner and Bruce Vavrichek. The
report benefited from comments by Robert Dennis, Timothy Gronniger, Douglas Hamilton,
and Thomas Woodward, all of CBO. Several outside reviewers also provided comments:
José Escarce of the University of California, Los Angeles, and RAND; Jonathan Skinner of
Dartmouth College and Dartmouth Medical School; and Douglas Staiger of Dartmouth
College. (The assistance of external reviewers implies no responsibility for the final product,
which rests solely with CBO.)
Michael Treadway and Kate Kelly edited the report, and Christine Bogusz proofread it.
Maureen Costantino designed and produced the cover, with assistance from Alshadye
Yemane, and prepared the report for publication. Lenny Skutnik produced the printed copies,
Linda Schimmel coordinated the print distribution, and Simone Thomas prepared the electronic
version for CBO’s Web site (www.cbo.gov).
Peter R. Orszag
Director
February