Operation ZIP Code

By Rachele Kanigel

To an alarming degree, where you live determines the quality of your health care. Before you get your next mammogram, sign up for surgery, or even fill a prescription, you must read this

For weeks you've suffered from yet another bout of back pain so severe you can hardly get out of bed in the morning. Your family doctor and the orthopedic surgeon she referred you to both say you're a good candidate for spine surgery. And it seems like everyone is having it--your next-door neighbor, your boss, the waitress at your favorite restaurant. You set a date for the procedure.

But what if you knew that your town had one of the highest rates of back surgery in the United States, nearly three times the national average? And that an orthopedic surgeon 50 miles away would advise you to wait awhile and see if the pain went away on its own? Would that change your decision?

Mounting research suggests that where you live plays a significant role in the health care you receive. "We've found that geography is often destiny," says James N. Weinstein, DO, MPH, director of the Dartmouth Institute for Health Policy and Clinical Practice, where this field of study was pioneered. "It's not that the rates of disease are different, it's the way they're treated that's different--from prevention to diagnosis to long-term care."

Luckily, you don't have to accept the health care your neighborhood allots you. By asking pointed questions of your physician, for instance, or knowing when to seek a second opinion from a specialist in another state, you can turn these differences to your advantage (see "4 Keys to Great Health Care," p. 156). Here, the region-by-region facts, as well as local hot spots that have questionable (or progressive) practices, and--most important--how to use this information to get the very best health care, wherever you call home.

The West

The States: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming

Prevention Is Neglected
When it comes to women's preventive health care, the West scores low. In 2006, less than 70% of women over age 40 in "big sky" states like Idaho, Utah, and Wyoming had gotten a mammogram in the past 2 years, compared with the national average of 77%, according to the CDC. The proportion of women getting Pap tests is also relatively low--though both tests have been shown to save lives by detecting cancer in treatable stages. Another preventive tool, cholesterol screening, also lags in many of these states.

Patients Are Informed
Medical decisions aren't always clear-cut. One person with terminal cancer, for instance, might want to try all available options, no matter how grueling--while another might prefer to enjoy her remaining days free of treatment and its side effects. In other words, the "right" decision is often a matter of how a patient weighs the pros and cons. With a pilot project started in 2007, Washington became the first state to push doctors to share all relevant information with anyone facing an important elective surgery. Experts say that those discussions are critical in allowing the patient's values to guide the decision.