Variations in health care:The good, the bad and the inexplicable

Maximising the good and minimising the bad in health care

John ApplebyChief Economist, The King’s FundApril 2011

Figure 1:Mapping the causes of variation

Figure 3: Distribution of crude rates and age–gender standardised rates for primary hipreplacement (English PCTs, 2009/10)

Figure 6: Age–gender standardised ratios for selected elective procedures (2009/10),England=100

Figure 9: Variation over time: SCVs for hip replacement, cataract removal and tonsillectomy2005/06, 2009/10

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Figure 11: Audit Commissionbasket of 25-day case procedures, 2009/10

Per cent carried outas day cases by PCT, ordered on size of coefficient of variation low = blackmedium = grey high = white

Figure 12: Measures of variation: selected low effectiveness procedures, 2009/10

‘If all variation were bad, solutions would be easy. The difficulty is in reducing the bad variation, which reflects the limits of professional knowledge and failures in its application, while preserving the good variation that makes care patient-centred.

‘When we fail, we provide services to patients who don’t need or wouldn’t choose them, while we withhold the same services from people who do or would, generally making far more costly errors of overuse than of underuse.’

Al MulleyDirector of the Dartmouth Center for Health Care Delivery Science at Dartmouth College and Professor of Medicine at Dartmouth Medical School

Download the full report:www.kingsfund.org.uk/variation