Author Affiliation: Primary Care Research Center Division of General Internal Medicine, San Francisco General Hospital, San Francisco, Calif.
More than 25
years ago, Wennberg and Gittelsohn1 observed that
communities in Vermont varied a great deal in the amount of health care
they used. Many others have since duplicated these findings of
variation in health care utilization across communities (ie, small-area
variation). Wennberg and colleagues2 concluded that
small-area variation in health care utilization could not be attributed
to how sick the population was who lived in various communities, nor to
differences in their health outcomes, but rather to irrational
physician decision making in the setting of uncertainty.
Bindman AB. Can Physician Profiles Be Trusted?. JAMA. 1999;281(22):2142–2143. doi:10.1001/jama.281.22.2142