Unwarranted variation

Unwarranted variation (or geographic variation) in health care service delivery, first so termed by Dr. John Wennberg, refers to differences that cannot be explained by illness, medical need, or the dictates of evidence-based medicine. It can be caused by shortfalls in three areas:

In 1967, while working in the Regional Medical Program created with a $350,000 grant from President Lyndon Johnson, Wennberg was analyzing Medicare data to determine how well hospitals and doctors were serving their communities. He found 4 types of variation: the underuse of effective care, variations in outcomes attributable to the quality of care, the misuse of preference-sensitive treatments, the overuse of supply-sensitive services.

According to Health Dialog, a privately held, for-profit disease-management company that was established to address unwarranted variation:

If you live in northern Idaho, and you develop back pain, chances are good that you’ll undergo surgery to treat your pain. Move to the southern tip of Texas, however, and the chances that you’ll undergo that same surgery will drop by a factor of 6. The surgery is no more effective in Idaho than it is in Texas. It’s just that doctors in the northwest are more likely than those in southern Texas to recommend surgery. This phenomenon, in which doctors practice medicine differently depending on where they’re from, is called practice pattern variation. And it isn’t limited to treating back pain, or even surgical decisions. There is also variation in treatment for chronic conditions, such as use of beta blockers for individuals with Congestive Heart Failure (CHF) or lipid testing for those with diabetes.

Dr. Wennberg and his colleagues at the Dartmouth Center for Evaluative Clinical Sciences have documented these wide variations in how healthcare is practiced around the country. They have also asserted that most of this variation is, in fact, unwarranted. Health Dialog was built to directly address unwarranted variation in healthcare: the overuse, underuse and misuse of medical care. Wennberg and his colleagues further concluded that if unwarranted variation in the healthcare system could be reduced, the quality of care would go up and healthcare costs would go down. Studies have shown that if unwarranted variation could be reduced in the Medicare population, quality of care would rise dramatically and costs could be lowered by as much as 30%.

Unwarranted variation in medical practice, as noted by Martin Sipkoff in 9 Ways To Reduce Unwarranted Variation, is costly and deadly. Analysis of Medicare data reveals that per-capita spending per enrollee in Miami is almost 2.5 times as great as in Minneapolis, even after adjusting data for age, sex, and race.

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Wikipedia