Table of contents

  1. Front Matter
    Pages i-xix
  2. John Wennberg, Klim McPherson, David C. Goodman
    Pages 1-24
  3. Judith D. de Jong, Peter P. Groenewegen, Gert P. Westert
    Pages 25-39
  4. Kimberlyn McGrail, Steven Lewis
    Pages 41-52
  5. Enrique Bernal-Delgado, Manuel Ridao-López, Sandra Garcia-Armesto
    Pages 53-78
  6. Gert P. Westert, Judith D. de Jong, Philip da Silva
    Pages 113-122
  7. Patricia TakSam Li, David C. Goodman, Astrid Guttmann
    Pages 123-140
  8. Ilir Hoxha, André Busato, Xhyljeta Luta
    Pages 141-160
  9. Elizabeth Lin, Zeynep Or, Magali Coldefy, Karen Urbanoski, Dallas Seitz, Corine Carlisle et al.
    Pages 161-198
  10. Michael Hammer, Hans Olav Melberg, Robert Fowler
    Pages 199-211
  11. David Alter, Mary Forhan
    Pages 213-229
  12. Gregory A. Roth, Jeremiah Brown, David J. Malenka
    Pages 231-257
  13. Muhammad U. Farooq, Dilip K. Pandey, Karen R. Burritt, Matthew J. Reeves, Philip B. Gorelick
    Pages 259-296
  14. Aparna Ingleshwar, Maria E. Suarez-Almazor
    Pages 297-322
  15. John-Michael Gamble, Sonia Butalia
    Pages 323-359
  16. Devon Richardson, David Urbach, Nancy Baxter
    Pages 361-381
  17. Tetsuya Otsubo, Yuichi Imanaka, Toshitaka Morishima, Noriko Sasaki, Sungchul Park, Jason Lee
    Pages 383-406
  18. Arlene S. Bierman, Joel S. Weissman
    Pages 407-431
  19. Jostein Grytten, Lars Monkerud, Rune Sørensen
    Pages 505-517

About this book


This title deals with internationally documented variations in medical practice and health service that exist across countries as well as regions across a specific country. Such variations raise critical concerns about the quality, equity and efficiency of health care resources across the world. Health services researchers have long been aware of large variations in the use of medical care across regions and medical providers. In the 1930s, the British pediatrician J.A. Glover observed that the rates of tonsillectomy in British schoolchildren varied widely, depending on the district where the students lived and the doctors who examined them. This volume provides a contextual landscape for the study of health care utilization through the lens of medical practice variations. It is grounded in the pioneering work by medical care epidemiologist, Dr. John Wennberg, who revealed wide variations in elective surgical rates across small areas in the U.S. and his findings that these variations were generally not explained by differences in population illness rates or patient preferences but rather, there were strong associations between supply of health care resources, such as hospital beds and physicians and health care utilization.

This volume introduces the concept of medical practice variations and its early history, outlines established concepts and frameworks, with an overview of methods used to understand the variations in medical care

. It makes the case for outcomes research in determining what works in health care and policy reforms to rationalize how care is delivered. Each chapter synthesizes the current published literature in the field and covers a description of medical practice variations in the area, determinants of these variations and outcomes. It outlines the most current research on specific types of utilization such as inpatient care, emergency services, elective surgery, primary care, obstetric and gynaec

ological care, mental health care and end-of-life care, among others. Studies of variation in condition-specific care focus on common conditions such as acute myocardial infarction, congestive heart failure, stroke, diabetes and procedures such as cancer surgery and joint replacement. Special topics include health care spending and quality, shared decision making and disparities.


Health Care Utilization Health Policy Reform Health Services Research Medical Care Epidemiology Outcomes Research

Editors and affiliations

  • Ana Johnson
    • 1
  • Thérèse A. Stukel
    • 2
  1. 1.DptofPublHlthSci,InstfrClnclEvltSciQueenCntrforHlthServs&PolicyRsrch,Queen'sUnivKingstonCanada
  2. 2.Institute forClinical EvaluativeSciencesTorontoCanada

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