When politicians talk of reforming the health care system to rein in costs, skeptical patients often worry that they will be forced to accept shoddy treatment in second-rate institutions. So it is a relief to learn that the famed Mayo Clinic in Minnesota and the renowned Cleveland Clinic in Ohio offer outstanding care at bargain prices  at least compared with higher-priced, equally prestigious medical centers elsewhere.

The comparison comes via the latest edition of the Dartmouth Atlas of Health Care, published by Dartmouth’s Institute for Health Policy and Clinical Practice. Researchers there have long pointed to large disparities in medical spending in different areas of the country and shown that patients usually do no better  and often fare worse  where the spending is highest.

This year’s atlas focuses on Medicare spending for patients in the last two years of life at the top five teaching hospitals, as ranked by U.S. News & World Report. The medical center at the University of California, Los Angeles, was the most extravagant, averaging some $93,000 per patient. Johns Hopkins, at $85,000, and Massachusetts General, at $78,000, came next. The Cleveland Clinic, at $55,000, and the Mayo Clinic, at $53,000, were far more cost-effective.

The reason for the disparities is not that one hospital charges a lot more for a given service than the others. Rather, the high-cost hospitals provide a lot more services for patients than the lower-cost hospitals: keeping patients in the hospital and in intensive care for longer periods, sending them to a slew of specialists and doing a lot more tests and procedures.