The author looks at various factors to explore small area differences in health care use between the California counties of Los Angeles (LA) and San Diego. CHIS data were used in the analysis. 

Findings: Physician supply was comparable between LA and San Diego. Fees per unit service were also equivalent. Hospital beds per 10,000 population were 35% higher in LA. Intensity of service use, particularly during the last 2 years of life, was significantly higher in LA, and costs were dramatically higher. Most of the differences were explained by discretionary hospital admissions, end-of-life care, and lower use of hospice care. Quality indicators favor San Diego. The author concludes that there is little reason to believe that the greater spending for health care in LA results in better patient outcomes.