This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Medical Practice  • Health Policy  • Medical Education  • Medical Practice, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Richard A. Cooper, MD

JAMA. 2009;302(10):1113-1114.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

As the nation embarks on health care reform, concerns have been raised that the United States is training too few physicians for the future.¹ However, progress in responding has been stalemated by a broadly accepted view that there is unexplained geographic variation in both physician supply and health care spending and that correcting it could obviate the need for more physicians—indeed, that less care is a value that should be rewarded.^2-3

What explains this "unexplained" variation? The answer lies in economic and social dynamics that operate separately at the communal and individual levels and that influence the use of health care resources and the outcomes they produce. Simply stated, wealthier communities have more resources, use more health care, and achieve better average outcomes—the vectors are linear and direct. Conversely, low-income individuals use the most health care resources, and those who use the most tend to have . . . [Full Text of this Article]

States as Communal Units of Health Care

Author Affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?