Getting a grip on clinical variations in hospital services

BMJ 2004; 328 doi: (Published 11 March 2004) Cite this as: BMJ 2004;328:610
  1. David J Hunter, professor of health policy and management (
  1. 1 School for Health, Wolfson Research Institute, University of Durham, Queen's Campus, Thornaby, Stockton on Tees TS17 6BH

    The findings reported by Wennberg and colleagues should come as no surprise to observers of the NHS and other healthcare systems.1 They are neither unique nor confined to the United States. It is an iron law of health policy that supply determines utilisation and demand. Elasticity of demand dictates that if beds are available then patients will be found to fill them, regardless of the appropriateness of such care.

    Wennberg and colleagues show starkly how, despite the assault on clinical practice by managers and politicians as they strive to control costs, improve quality, and tackle unexplained variations in clinical practice and outcomes, the power to determine what happens within health services resides …

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