“Reducing Variation in Health Care: The Rhetorical Politics of a Policy Idea”

From a new paper in the Journal of Health Politics, Policy and Law (JHPPL) by Sandra Tanenbaum:

The finding of variation, unlike much in health policy, confers a measure of hope. The project to reduce variation is buoyed by a sense of the possible. If different physicians, regions, even nations do things differently — and without apparent adverse effects — there are extant, reasonable alternatives to the status quo; these can be studied and replicated or adapted. In a health polity that is accustomed to alternatives that are never proposed, or proposed and not passed, or passed and not implemented, or implemented to no avail, the identification of an alternative that is already working somewhere is a heady experience. The Commonwealth Fund’s (n.d.) cross-national research has a similar effect. It is not only the finding that Americans have worse outcomes than nations that spend less, but the very fact that nations with better outcomes can spend less, that communicates that we can do better and shame on us if we do not. Atul Gawande’s (2009) treatment of cost variation in two Texas cities provides a twist on this argument when he finds that physicians in the higher-spending city participate in a culture of greed; here spending less is not only as effective but is morally superior. Still, even without the moral overlay, Gawande shows us that the lower-spending city exists and that its residents are equally healthy. This is the allure of the variations discourse. Lower costs and higher quality are not only possible. They are already here.

Though I would take issue with some of its content, the paper is an interesting read from beginning to end.


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