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Invited Commentary
February 2016

Does Decreasing Variability Affect Quality?

Author Affiliations
  • 1Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Surg. 2016;151(2):163. doi:10.1001/jamasurg.2015.3654

The cost of health care in the United States has been the topic of countless studies during the last several decades. Many remedies have been proposed and implemented, but cost continues to rise. One puzzling aspect of cost has been the variability of cost for the same disease process. Variability in the cost of surgical procedures has been easier to evaluate than other aspects of health care and has generated significant interest from a policy standpoint.

Variability. This seems like something obvious. Everyone would like to make health care outcomes better and variability seems like a great place to start. But, is this code for further erosion of the autonomy of surgeons and health care professionals in general? Surgeons are intrinsically skeptical of this process and believe with perhaps some justification that clinical pathways will be developed that focus more on cost than clinical outcome. And, variability is code for decreasing cost, not bringing costs to the mean.

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