How Likely Are You to Have Heart Surgery? A C-Section? Depends Where You Live

"Location, location, location" may be a well-known maxim in real estate, but it applies in health care, too. Where you live matters in terms of what treatment you will receive for a given condition.

A new statewide survey published Tuesday found significant variation in the rate of 13 common elective procedures for several health conditions -- including heart disease, childbirth and arthritis of the hip or knee. Treatments for these conditions are considered "elective" because deciding which treatment is best (or deciding on no treatment at all) can depend on someone's preference.

It would be ideal if the patient was fully informed of all treatment options and made a decision based on his or her own preferences. But often it's the doctor's preferences that drive the decision.

The California Healthcare Foundation has been tracking this variation in its ongoing "All Over the Map" initiative. It previously published data about variation for these elective conditions from 2005 through 2008. This update looks at 2009 through 2012.

Some highlights from the survey, which looked at changes in the rates of procedures between the two time periods studied:

• In Deer Park (Napa County), the rate of knee replacement surgery increased by 62 percent. People there are twice as likely to have knee replacement as people in Hawthorne (Los Angeles County).
• For women having babies in Paramount (L.A. County), the rate of cesarean section increased 25 percent, and women there were more than twice as likely to deliver by C-section as women in Grass Valley, where the C-section rate dropped by 24 percent.
• In Fresno, people are more than twice as likely to have angiography, compared with the statewide average.

You can use the interactive map to look up rates for these procedures where you live. You might find pleasant surprises. Health advocates have been working to reduce rates of C-section. Woodland, Sonoma, Grass Valley and Davis are all Northern California cities with C-section rates well below the statewide average.

Maribeth Shannon helps oversee the "All Over The Map" project for the foundation. She says that if patients were informed and making decisions about care, rates of procedures would average out over time.

It's also important to note that there's no known "right" rate, although the statewide average is a reasonable benchmark, she says.

"You wouldn't think that people in Southern California would make a dramatically different decisions as people in Northern California with the same symptoms," she said. "If people are fully informed, there'd be a range of options that people would choose ... but you wouldn't see a decision based on geography."

In an interview, Shannon elaborated on the spike in knee replacement surgeries in Deer Park. There was a successful knee replacement surgeon in Red Bluff, she told me, and that area had a "much, much higher knee replacement rate." That surgeon moved to St. Helena, in Napa County, and then that area experienced a "dramatic increase" in knee replacements. "The difference seemed to be the presence of a surgeon who was good at doing knee replacement and did a lot, had very high volume."

"So to me that's a really great example of what's driving (an increased rate) tends to be the surgeon's preference, rather than the patient's preference," she said. There are a range of options for knee pain, she said, everything from no treatment at all, to management with medication to physical therapy.

"You wouldn't want a lot of people, who perhaps would have been happy with physical therapy, opting for knee replacement because that's the only option given to them by their surgeon."

The question becomes a problem for society at large because if patients would have chosen a lesser therapy, if only they had known of it, then health care costs are being driven up unnecessarily.