The Dartmouth Atlas of Children's Health Care in Northern New England

Doctor examines a young girl.

Where children live affects the health care they receive—sometimes receiving too little care but other times getting unnecessary imaging tests.



The Issue:

In their first-ever study of pediatric care, investigators with the Dartmouth Atlas Project have documented variations in pediatric care in northern New England (Maine, New Hampshire, and Vermont) where legislatures require routine reporting to an All Payer Claims Database.

Key Findings

  • HSAs with higher rates of poverty had fewer physicians, lower office visit rates, and more emergency department visits.

  • Pediatrician supply varied from 7 physicians per 100,000 children (Sanford, Maine) to 280 per 100,000 (Lebanon, N.H.).

  • Annual office visits ranged from 1.2 visits per child (Houlton, Maine) to 3.6 (St. Albans and Bennington, Vt.).

  • Children received chest or abdominal CT scans more frequently in Bennington, Vt. (15 per 1,000 children) than Machias, Maine (4 per 1,000).


Unwanted variations in care occur when there are differences in the availability of resources, such as physicians, hospital beds, and imaging units. Quality of care suffers with too little or too much care.

About the Study:

The data is from 691,000 mostly White, non-Hispanic children (90%) living in small cities, towns, and rural areas in in 2010.