Inconvenient truths about supplier induced demand and unwarranted variation in medical practiceBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4073 (Published 20 October 2009) Cite this as: BMJ 2009;339:b4073
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Wennberg's pioneering work on variation has been neglected
for too long, especially in the UK where, despite a number
of experts agreeing it would be a good idea to repeat it, no
body with any funding has agreed to pay for it.
Might I suggest a new incentive for spending that money?
The Dartmouth Atlas work estimated that about 1 in 3 dollars
spent on health in the USA either harmed patients or
demonstrably delivered no benefit to them. If anything like
this sort of variability exists in the NHS, then it presents
the single biggest opportunity to save costs without
compromising quality. I have seen hints in my own work that
the variation in the NHS is just as large (though this is
based on initial, incomplete and non-rigorous analysis done
for other purposes).
Our ability to keep spending on the NHS over the next 5-10
years will be severely constrained (see, for example, the
King's Fund report "How Cold Will it Be?" here
ill_it_be.html). Many of the mechanisms currently being
proposed to achieve savings are both unproven and difficult
to implement. Identifying and reducing variation in the NHS
could deliver bigger gains with no risk to quality.
Maybe, before we submit the NHS to further paroxysms of
reorganization designed to make the savings we know must be
made, we should investigate just how much we could gain by
driving out unwarranted variation.
Is sometimes paid to advise
the NHS on related issues.
Competing interests: No competing interests