Only a few years ago, it looked as if the U.S. had finally managed to put a leash on surging health-care expenditures, which consume some 14% of gross domestic product. Now, with costs picking up steam again, the search is on for ways to control spending--not only to ease the pain for current employers, workers, and taxpayers, but also to lighten the massive burden that lies ahead when the baby boom generation enters its retirement years.

One potentially useful tack is suggested by a new study by economist Jonathan Skinner of Dartmouth College and physician John E. Wennberg of Dartmouth Medical School that focuses on geographic disparities in Medicare spending. Specifically, the study looks at differences in outlays and care for patients in the last six months of their lives, a period that accounts for some 30% of total Medicare expenditures.