Intended for healthcare professionals

Views & Reviews From the Frontline

The cause of clinical variance

BMJ 2013; 346 doi: (Published 19 February 2013) Cite this as: BMJ 2013;346:f1122
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

Why does the United States spend so much on healthcare yet have such poor health outcomes? Why do many patients from the developing world believe that “injections” are a cure-all? The answer is simple: financial incentives are grossly disfiguring world healthcare. Pay doctors to intervene, and they duly will, irrespective of the harms caused. A nation’s health seeking behaviour is solely defined by the payment structure of its healthcare system. Thus, private systems have a vested interest in making us all patients, for this is just …

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