Variation Across Payers IOM Findings: Geographic Variations in Medicare and Private Health Care Spending Variation Across Payers Spending per person in Medicare and private payers are not correlated across local regions However, utilization of services is correlated Geographic variation in Medicare and private $ only partially explained by health and demographic factors Variation Within Payers Medicare: Spending varies by 50% across the country Post-acute services costs explain disproportionate share of geographic variation Private health insurance: Variation mainly (70%) a result of differences in prices paid to providers, not use patterns Consistency Over Time High-cost areas remain high Source: Institute of Medicine. Variation in Health Care Spending: Target Decision Making, Not Geography (Washington D.C.: National Academies Press, July 2013).