Virtual Mentor. November 1999, Volume 1, Number 3.

Ethics Poll

Geographic Variations in the Use of Health Services

The Ethics Poll is a snapshot of the opinions of interested readers.

The existence of geographic variation raises the following question: what is the "correct" rate of utilization of health care services? This question encompasses important quality of care and distributive justice issues. Given differences in the rates of health care utilization, what do you think is the primary reason for the observed geographic variation?

Poor diffusion of clinical practice guidelines
Differences in patient clinical severity
Differences in patient preferences of clinical treatment
Varying supply of health care resources (ie number of hospital beds in a given locale)
Varying financial incentives for physicians

Poll Results

Given differences in the rates of health care utilization, what do you think is the primary reason for the observed geographic variation?
29 votes recorded

Poor diffusion of clinical practice guidelines
14 Votes - 48%

Differences in patient clinical severity
0 Votes - 0%

Differences in patient preferences of clinical treatment
0 Votes - 0%

Varying supply of health care resources (i.e., number of hospital beds in a given locale)
9 Votes - 31%

Varying financial incentives for physicians
6 Vote - 20%

Related Articles

  • Alexander JA, Lee SY, Griffith JR, Mick SS, Lin X, Banaszak-Holl J. Do market-level hospital and physician resources affect small are variation in hospital use? Med Care Res Rev. 1999;56:94-117. Abstract available at: PubMed. Accessed October 14, 1999.
  • O'Connor GT, Quinton HB, Traven ND, Ramunno LD, Dodds TA, Marciniak TA, Wennberg JE. Geographic variation in the treatment of acute myocardial infarction: the Cooperative Cardiovascular Project. JAMA. 1999;281:627-633. Available at: JAMA. Accessed October 14, 1999.
  • Ashton CM, et al. Geographic variations in utilization rates in Veterans Affairs hospitals and clinics. N Engl J Med. 1999;340:32-39. Abstract available at: PubMed. Accessed October 14, 1999.
  • Wennberg JE. Understanding geographic variations in health care delivery. N Engl J Med. 1999;340:52-53. Abstract available at: PubMed. Accessed October 14, 1999.
  • Birkmeyer JD, Sharp SM, Finlayson SR, Fisher ES, Wennberg JE. Variation profiles of common surgical procedures. Surgery. 1998;124:917-923. Abstract available at: PubMed. Accessed October 14, 1999.
  • Pritchard RS, et al. Influence of patient preferences and local health system characteristics on the place of death. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Risk and Outcomes of Treatment. J Am Geriatr Soc. 1998;46:1242-1250. Abstract available at: PubMed. Accessed October 14, 1999.
  • Krumholz HM, Radford MJ, Wang Y, Chen J, Heiat A, Marciniak TA. National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infaction: National Cooperative Cardiovascular Project. JAMA. 1998;280:623-629. Abstract available at: PubMed. Accessed October 14, 1999.
  • Green LA. Practical issues in conducting small-area variation analysis. Fam Med. 1996;28:277-281. Abstract available at: PubMed. Accessed October 14, 1999.
  • Chan B, Cox JL, Anderson G. Trends in the utilization of noninvasive cardiac diagnostic tests in Ontario from fiscal year 1989/90 to 1992/93. Can J Cardiol. 1996;12:237-248. Abstract available at: PubMed. Accessed October 14, 1999.
  • Mirvis DM, Burns R, Gaschen L, Cloar FT, Graney M. Variation in utilization of cardiac procedures in the Department of Veterans Affairs health care system: effect of race. J Am Coll Cardiol. 1994;24:1297-1304. Abstract available at: PubMed. Accessed October 14, 1999.
  • Ugnat AM, Naylor CD. Regionalized delivery and variable utilization of coronary artery bypass grafting in Ontario from 1981 to 1991. CMAJ. 1994;151:575-580. Abstract available at: PubMed. Accessed October 14, 1999.
  • Grill R, Repetto F. Variation in use of breast-conserving surgery in Lombardia, Italy. Int J Technol Assess Health Care. 1995;11:733-740. Abstract available at: PubMed. Accessed October 14, 1999.
  • Cave DG. Small-area variations in the treatment of prevalent medical conditions: a comparison of three cities in the Northeast. J Ambulatory Care Manage. 1995;18:42-57. Abstract available at: PubMed. Accessed October 14, 1999.
  • Gillespie KN, Romeis JC, Virgo KS, Fletcher JW, Elixhauser A. Practice pattern variation between two medical schools. Med Care. 1989;27:537-542. Abstract available at: PubMed. Accessed October 14, 1999.
  • For more information about geographic variation in health care utilization, visit http://www.dartmouth.edu/~atlas/.
Poll results reflect the opinions of visitors to the site who voluntarily answer the poll questions. Those visitors do not represent a random sample of Virtual Mentor readers. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.