Health Affairs

Posting date: October 7, 2004

This Article Reprint (PDF) Table of Contents HTML Version Submit a response to this article Alert me when this article is cited Alert me when Comments are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Archive Download to Citation Manager Reprints & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wennberg, J. E. Search for Related Content PubMed PubMed Citation Articles by Wennberg, J. E. Related Collections Health Reform Hospitals Medicare Physicians Quality Of Care Workforce Issues Politics Variations Related Articles

Health Affairs, 10.1377/hlthaff.var.140
Copyright © 2004 by Project HOPE

Web Exclusives

Perspective: Practice Variations And Health Care Reform: Connecting The Dots

John E. Wennberg ^1*

¹ John Wennberg directs the Center for the Evaluative Clinical Sciences at Dartmouth Medical School in Hanover, New Hampshire.

^*Corresponding author.

Abstract

Unwarranted variation is a ubiquitous feature of U.S. health care. Remedies for variations exist, and several are described in the current collection of Health Affairs papers. Several obstacles stand in the way of widespread adoption of these remedies: (1) a quality agenda that has yet to focus on improving the quality of patient decision making; (2) economic incentives that do not reward exemplary practice; and (3) the poor state of clinical science. Medicare reform legislation creates the opportunity for a demonstration project to redesign health care to address these barriers. We also must grapple with the cultural bias that more care is better and that physicians must know best.

Key Words: Health Reform, Hospitals, Medicare, Physicians, Quality Of Care, Workforce Issues, Politics, Variations

                      What's this?

Related Articles

• John E. Wennberg, Elliott S. Fisher, Thérèse A. Stukel, and Sandra M. Sharp
  Use Of Medicare Claims Data To Monitor Provider-Specific Performance Among Patients With Severe Chronic Illness
  Health Affairs Web Exclusive, October 7, 2004
  [Abstract] [PDF] [Table of Contents][Supplemental Exhibits][HTML Version]
   
  
• Elliott S. Fisher, David E. Wennberg, Thérèse A. Stukel, and Daniel J. Gottlieb
  Variations In The Longitudinal Efficiency Of Academic Medical Centers
  Health Affairs Web Exclusive, October 7, 2004
  [Abstract] [PDF] [Table of Contents][Appendix Tables][HTML Version]
   
  
• Katherine Baicker, Amitabh Chandra, Jonathan S. Skinner, and John E. Wennberg
  Who You Are And Where You Live: How Race And Geography Affect The Treatment Of Medicare Beneficiaries
  Health Affairs Web Exclusive, October 7, 2004
  [Abstract] [PDF] [Table of Contents][Appendix Exhibits][HTML Version]
   
  
• Justin B. Dimick, Samuel R.G. Finlayson, and John D. Birkmeyer
  Regional Availability Of High-Volume Hospitals For Major Surgery
  Health Affairs Web Exclusive, October 7, 2004
  [Abstract] [PDF] [Table of Contents][Supplemental Exhibits][HTML Version]
   
  
• Karen R. Sepucha, Floyd J. Fowler Jr., and Albert G. Mulley Jr.
  Policy Support For Patient-Centered Care: The Need For Measurable Improvements In Decision Quality
  Health Affairs Web Exclusive, October 7, 2004
  [Abstract] [PDF] [Table of Contents][HTML Version]
   
  
• Annette M. O’Connor, Hilary A. Llewellyn-Thomas, and Ann Barry Flood
  Modifying Unwarranted Variations In Health Care: Shared Decision Making Using Patient Decision Aids
  Health Affairs Web Exclusive, October 7, 2004
  [Abstract] [PDF] [Table of Contents][HTML Version]
   
  
• James N. Weinstein, Kristen K. Bronner, Tamara Shawver Morgan, and John E. Wennberg
  Trends: Trends And Geographic Variations In Major Surgery For Degenerative Diseases Of The Hip, Knee, And Spine
  Health Affairs Web Exclusive, October 7, 2004
  [Abstract] [PDF] [Table of Contents][Supplemental Exhibit][HTML Version]
   
  
• David C. Goodman
  Trends: Twenty-Year Trends In Regional Variations In The U.S. Physician Workforce
  Health Affairs Web Exclusive, October 7, 2004
  [Abstract] [PDF] [Table of Contents][HTML Version]
   
  
• Paul Harrington
  Perspective: Quality As A System Property: Section 646 Of The Medicare Modernization Act
  Health Affairs Web Exclusive, October 7, 2004
  [Abstract] [PDF] [Table of Contents][HTML Version]
   
  

This article has been cited by other articles:

				A. Weil How Far Can States Take Health Reform? Health Aff., May 1, 2008; 27(3): 736 - 747. [Abstract] [Full Text] [PDF]

				J. J. Cohen, S. Cruess, and C. Davidson Alliance Between Society and Medicine: The Public's Stake in Medical Professionalism JAMA, August 8, 2007; 298(6): 670 - 673. [Full Text] [PDF]

				J. Billings, J. Dixon, T. Mijanovich, and D. Wennberg Case finding for patients at risk of readmission to hospital: development of algorithm to identify high risk patients BMJ, August 12, 2006; 333(7563): 327. [Abstract] [Full Text] [PDF]

				D. H. Au, E. M. Udris, S. D. Fihn, M. B. McDonell, and J. R. Curtis Differences in health care utilization at the end of life among patients with chronic obstructive pulmonary disease and patients with lung cancer. Arch Intern Med, February 13, 2006; 166(3): 326 - 331. [Abstract] [Full Text] [PDF]