"There was substantial local variation in health care (drug and nondrug) utilization and spending. Furthermore, many of the low-spending hospital service areas (HSAs) were located in high-spending hospital referral regions (HRRs), and many of the high-spending HSAs were in low-spending HRRs.... The effectiveness of payment reforms in reducing overutilization while maintaining access to high-quality care depends on the effectiveness of targeting.... HRR-based policies may be too crudely targeted to promote the best use of health care resources."  MORE >>