The best places in the U.S. for the ill to retire

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The adage, "healthcare is local" rings true. When it comes to choosing a place to retire, the quality of a city's local healthcare system becomes increasingly important to keep in mind.

Healthcare researchers have studied the geographic variation in the delivery of healthcare services for decades to understand what accounts for the differences. In its report, "Our Parents, Ourselves: Health Care for an Aging Population," the Dartmouth Atlas Project uses Medicare claims data to examine healthcare for older Americans across the nation, comparing factors such as the number and types of care providers they see and the frequency with which they have contact with the healthcare system in different regions.

According to the U.S. Census Bureau, there were an estimated 19.2 million Americans age 75 or older in 2012, accounting for roughly 6.1 percent of the total population. Driven largely by the aging of the baby boomer generation, the Bureau projects this figure to rise to 23.2 million (6.9 percent) by 2020 and 34.2 million (9.5 percent) by 2030.

Here are five findings from the report on the variance of the delivery of healthcare services across the U.S. from 2012, the latest year for which data is available.

1. Number of days in contact with the healthcare system. In 2012, the average Medicare beneficiary had some kind of contact with the healthcare system on approximately 17 different days. In general, patients living in Florida, the metropolitan Northeast and parts of California had higher than average numbers of contact days, while the Midwest and Northwest had lower rates — fewer than 14 days of contact.

Beneficiaries living in six hospital referral regions — including East Long Island, N.Y. (24.9 days), Manhattan, N.Y. (24.6), Fort Lauderdale, Fla. (24.3), and Miami (22.2) — exceeded the national average by at least five days. By contrast, beneficiaries in three regions — Lebanon, N.H. (10.2), Marquette, Mich. (10.3) and Minot, N.D. (10.7) — spent about one week less than average in contact with the health care system in 2012.

2. Areas with the highest and lowest proportion of beneficiaries with a primary care physician as their predominant provider. An average of 56.9 percent of Medicare beneficiaries had a PCP as their principal healthcare provider in 2012, but this percentage varied across different regions. Primary care specialties were most often predominant in Eastern and Midwestern states, such as Pennsylvania, Virginia, Ohio, Michigan and Kansas. The Southwest and West used PCPs as a predominant provider less often.

More than 70 percent of beneficiaries had PCPs as their main providers in York, Pa. (73.4 percent), McAllen, Texas (70.9 percent) and Jonesboro, Ark. (70.8 percent). Fewer than half had PCPs as their predominant providers in the Gulf Coast regions of Metairie, La. (42.6 percent), Gulfport, Miss. (43.4 percent) and New Orleans (45.8 percent).

3. Areas with the highest and lowest number of unique physician visits per beneficiary per year. The number of unique physicians beneficiaries see each year provides a measure of the complexity and fragmentation of care for older adults. Medicare beneficiaries, on average, saw 3.4 different clinicians in 2012. Beneficiaries living on the East Coast, the Gulf Coast and in Arizona tended to have more clinicians involved in their care than beneficiaries elsewhere in the country. In Florida, a popular destination for retirees, patients saw more than four different clinicians in four regions: Fort Lauderdale (4.7), Fort Myers (4.2), Sarasota (4.2) and Bradenton (4.1). Patients saw fewer than three different clinicians in regions such as Bangor, Maine (2.4) and Marquette, Mich. (2.5).

4. Areas with the highest and lowest proportion of beneficiaries who had an annual wellness visit. Under the Affordable Care Act, Medicare beneficiaries have access to an annual wellness visit, which includes an overall assessment and review of the individual's functional ability and personalized prevention planning. About 10.7 percent of Medicare beneficiaries had an annual wellness visit in 2012, the first full year of its availability. Areas with high utilization of annual wellness visits were scattered across the country, with higher concentrations in New England and the Upper Midwest. In many central regions of the country, fewer than 5 percent of Medicare beneficiaries had an annual wellness visit in 2012.

5. Areas with the highest and lowest number of days spent in an in-patient setting. In 2012, Medicare beneficiaries spent an average of 4.6 days in inpatient settings, including hospitals and skilled nursing facilities. States with the highest numbers of inpatient days in 2012 include Illinois, Indiana, Kentucky, Ohio, Pennsylvania and Louisiana. The Western and Mountain states had the fewest inpatient days — less than four per beneficiary.

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