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This report, a collaborative project with the Foundation for Informed Medical Decision Making, looks at the variation in surgical rates in 306 hospital referral regions across the United States (a hospital referral region is a large health care market containing at least one referral hospital). This report is divided into three parts. The first section, "The Importance of Choice in Health Care," explains the concept of shared decision-making, a process that helps patients understand their choices fully and allows them to share treatment decisions with their clinicians. The second section, "Variation in Preference-Sensitive Care," briefly describes the treatment choices facing patients with eight different conditions, all of which can--but do not have to be--treated with surgery. The last section, "Ensuring Patients Get the Care They Need and Want," discusses steps patients can take to make sure they get the care they want and need. It also discusses how physicians and other clinicians can support shared decision-making to ensure that patients make fully informed choices. When done right, shared decision-making results in a better decision: a personalized choice based on the best scientific evidence and the patient's own values.

Clinical medicine --- Decision making.

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For patients whose conditions can be treated with elective surgery, location matters. In this Dartmouth Atlas report, the sixth in a series of nine U.S. regional reports, we show the wide regional variation in the likelihood that patients with similar conditions receive elective procedures. This report highlights the Great Plains region (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota) and shows the variation across the region and the United States.

Geography, Medical.

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For patients whose conditions can be treated with elective surgery, location matters. In this Dartmouth Atlas report, the eighth in a series of nine U.S. regional reports, we show the wide regional variation in the likelihood that patients with similar conditions receive elective procedures. This report highlights the Mountain states (Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, and Wyoming) and shows the variation across the region and the United States.

Clinical medicine --- Decision making.

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For patients whose conditions can be treated with elective surgery, location matters. In this Dartmouth Atlas report, the fourth in a series of nine U.S. regional reports, we show the wide regional variation in the likelihood that patients with similar conditions receive elective procedures. This report highlights the Great Lakes region (Illinois, Indiana, Michigan, Ohio, and Wisconsin) and shows the variation across the region and the United States.

Geography, Medical.

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Andy Lazris, MD, is a practicing primary care physician who experiences the effects of Medicare policy on a daily basis. As a result, he believes that the way we care for our elderly has taken a wrong turn and that Medicare is complicit in creating the very problems it seeks to solve. Aging is not a disease to be cured; it is a life stage to be lived. Lazris argues that aggressive treatments cannot change that fact but only get in the way and decrease quality of life. Unfortunately, Medicare's payment structure and rules deprive the elderly of the chance to pursue less aggressive care, which often yields the most humane and effective results. Medicare encourages and will pay more readily for hospitalization than for palliative and home care. It encourages and pays for high-tech assaults on disease rather than for the primary care that can make a real difference in the lives of the elderly.Lazris offers straightforward solutions to ensure Medicare's solvency through sensible cost-effective plans that do not restrict patient choice or negate the doctor-patient relationship. Using both data and personal stories, he shows how Medicare needs to change in structure and purpose as the population ages, the physician pool becomes more specialized, and new medical technology becomes available. Curing Medicare demonstrates which medical interventions (medicines, tests, procedures) work and which can be harmful in many common conditions in the elderly; the harms and benefits of hospitalization; the current culture of long-term care; and how Medicare often promotes care that is ineffective, expensive, and contrary to what many elderly patients and their families really want.

Geriatrics --- Older people --- Medicare. --- Medicine --- Gerontology --- Medicare --- Health insurance --- Medicaid --- Medigap --- Medical care --- Diseases --- Health and hygiene