„Health care professionals need to be leaders“

1973, more than 40 years ago, Wennberg and Gittelsohn wrote their Science article on „small area variations“. Since 1994, for more than 20 years, he publish the Dartmouth Atlas of Health Care, which documents glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide comprehensive information and analysis about national, regional and local markets, as well as individual hospitals and their affiliated physicians. These reports and the health services research, on which they are based, helps policy-makers, the media, many supply researchers, consultants and others to assess the efficiency and effectiveness of the American health care system much more accurately. Publically available medical claims data was the basis for American health care reforms, especially for „Obamacare“, the Affordable Care Act.

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Erstveröffentlichungsdatum: 31.03.2015


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>> The Atlas and the reports are accompanied by your elaborate website with lots of interactive tools to help visitors and health care researchers to perform their own comparisons and analyses for specific regions. These opportunities are widely used. You are also presenting findings in a user-friendly form, so that they have as great an impact as possible not only in professional circles but also in the general public and health politics. Isn’t it a scandal that there are great differences in medical care? Should not every doctor and every hospital provide top standard? Ought not all health insurance companies and every health care provider to be ashamed of these differences? Wouldn’t it even be better if the variations were not reported, so that the trust towards doctors and the health system is not at risk?
We expect some differences in medical care. After all, populations differ in their needs and wants by regions and providers. But variation that isn’t explained by population differences indicates differences in the way that health care is delivered and can help identify serious problems with health care that we can identify and improve.  Measuring health care is as important as measuring health. Information about variation in the performance of health care systems should be routinely measured and freely available. Trust is based upon a foundation of honesty, and we, as health care professionals, need to be leaders in self-evaluation, public disclosure, and efforts to improving quality and efficiency.

You see the regional differences as a positive thing? Why?
Variation by itself is not always a problem. If a region has higher disease burden, the population should receive more care to meet those needs. This is termed warranted variation. Unwarranted (or unwanted) variation is not explained by differences in population needs or wants. Low variation is not always desirable if it indicates uniform low care quality. Uniform high quality, is of course, highly desirable.

Who in the health system is responsible for documenting and analysing the regional differences in health care? Which actor of the health system is under obligation? Who should pay for the research?
The responsibility for monitoring health care is shared broadly. Health care professionals and hospitals have a responsibility to ensure that they are providing high quality care at the lowest reasonable cost. Health care researchers have a responsibility to investigate the causes and consequences of variation. Public agencies that are responsible for national or regional health care have a responsibility to monitor care and ensure transparency to the public. Problems in measuring variation occur when health system actors claim ownership of data about the public usually under the guise of “protecting” patient confidentiality. Responsible ...  <<