Published 20 October 2009, doi:10.1136/bmj.b4073
Cite this as: BMJ 2009;339:b4073

Analysis

Inconvenient truths about supplier induced demand and unwarranted variation in medical practice

¹ General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA, ² Harvard Medical School, Boston, MA

Doctors need to confront the implications of variation in clinical practice and improve the quality of medical decision making

The first 150 words of the full text of this article appear below.

The United States spends 17% of its gross domestic product on health care, the highest of any country, yet does not produce measurably better health. The per capita spending in 2006 for the government Medicare programme for people aged 65 ranged from $5310 to $16 352 in the country’s 306 hospital referral regions, and rigorous analyses suggest that one dollar is wasted for every two that are well spent.^{1 2 3} Is such variation, and the implied overuse of care in some regions, the result of America’s heavy reliance on market mechanisms and resulting supplier induced demand for services or are there more general lessons for all healthcare economies about the quality of medical decisions?

The first systematic account of practice variation was Glover’s 1938 report on the incidence of tonsillectomy among schoolchildren in England and Wales.⁴ He found a tenfold variation in tonsillectomy rates from one region to another. Although he . . . [Full text of this article]

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The NHS needs this analysis more than ever

stephen black
bmj.com, 9 Nov 2009 [Full text]

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