Practice patterns: are they independent of financing system?

Let’s not be too quick to point to large practice pattern variation as a symptom of the organization and financing arrangements of the American health care system.

From Chris Weaver of Kaiser Health News:

Medicare patients in Fort Myers, Fla., were more than twice as likely to receive hip replacement surgeries in 2005 and 2006 as their counterparts across the Everglades in Miami, according to a finding by Dartmouth Health Atlas researchers. […]

But, before you blame such inconsistencies on America’s money-driven health system, take a look at Britain’s effort to anglicize the Dartmouth work: Doctors in some areas such as the college town of Oxford do one type of hip replacement at rates up to 16 times greater than in places like London, according to a November atlas by the National Health Service.

The British atlas is surprising because “doctors are not by and large paid on a fee for service basis in the NHS,” Angela Coulter, director of global initiatives for the Dartmouth Atlas-associated Foundation for Informed Medical Decision Making, said at a Salzburg Global Seminar session this week. “It illustrates the fact… that doctors tend to favor the treatments they’re trained to provide,” even when money isn’t a factor. Most British doctors get salaries rather than payments for each procedure like their American colleagues.

Variations in the way doctors treat patients are “independent of the way health care’s organized and financed,” Dr. Jack Wennberg, the godfather of Dartmouth’s variation research, said in an interview here Thursday, noting that his work uncovered similar patterns in Britain and Norway in the 1970s.

I believe this is the site for the UK variation atlas.

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