Variation in use – a historical
perspective
n Originate in the phenomenon of practice pattern variations described
by Wennberg and his associates in a continuing series of studies
starting in the mid 70’s
These papers demonstrated substantial geographical variation in
the aggregate use of physician and hospital services
And in specific utilization rates of common surgical and radiologic
procedures
The authors argued that these variations neither reflect an intrinsic
variation in the prevalence of specific conditions, nor are
explained by differing patient preferences,
n What they do represent is still a matter of considerable debate
n Nevertheless appears to be general agreement that such variations are
a symptom of something seriously wrong with our health system
Which should either be addressed for its own sake or as a way of
controlling health care costs
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