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Commentary: the Dutch approach to unwarranted medical practice variation

BMJ 2011; 342 doi: (Published 17 March 2011) Cite this as: BMJ 2011;342:d1429
  1. Gert P Westert, full professor of health services research,
  2. Marjan Faber, senior researcher
  1. 1Radboud University Nijmegen Medical Centre, PO Box 9101, 114 IQ Healthcare, Nijmegen, 6500 HB, Netherlands
  1. Correspondence to: G Westert g.westert{at}

Medical practice varies considerably, both within and between countries. Rates of surgical procedures and medical treatment seem to be unrelated to illness and other patient related factors in many studies.1 Wennberg makes the intriguing observation that supply is the prime determinant of healthcare usage in the United States: most unwarranted healthcare is given in areas with high supply levels and does not result in improved patient outcomes. 1

Wennberg defines three categories of care: effective care, preference sensitive care, and supply sensitive care, with supply factors relating to overuse in the last two categories. Supply levels in the Netherlands vary less than in the US. This is because healthcare supply in the Netherlands was—at least until 2006—centrally planned and controlled by the government. You might therefore expect that variations in delivery of healthcare would be insignificant. Unfortunately, this is not the case. The 2010 Dutch healthcare performance report notes remarkable variations in quality and price of healthcare between care providers.2 For …

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