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updated 10/13/2004 12:57:20 PM ET 2004-10-13T16:57:20

We tend to think that high-tech medicine — blockbuster pills and expensive surgeries — is behind our skyrocketing national medical bill. But inefficiency may be a much more powerful part of the problem than we realize.

Take this stunner: States that spend the most money per Medicare patient actually tend to give lower-quality health care than those that are frugal.

That's according to a study published recently in the medical journal Health Affairs by economists at Dartmouth College. Using the Dartmouth data, we've assembled a list of the states that spend the most.

States are ranked from one to 50, low spending to high. That's combined with a quality ranking from a landmark study by Stephen Jencks, from the Centers for Medicare and Medicaid Services in Baltimore, Md., determining if patients got basic care, such as blood thinners for those at risk of stroke and blood pressure meds to prevent heart attacks. Quality rankings run best (1) to worst (51).

We've also ranked, from best to worse, the number of general practitioners states have per 10,000 patients. According to Kate Baicker, one of the Dartmouth economists, states with more general practitioners seem to spend less and have better quality care — perhaps because primary care docs help make sure patients have the most basic, effective care.

Baicker stops short of saying the extra money is entirely wasted. “We can't say there's no benefit from the extra spending,” says Baicker. “But we think the dollars could be spent so much more effectively. It's entirely possible we're throwing money away.”

© 2012 Forbes.com

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