john appleby: variations in health care

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Post on 14-Dec-2014



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John Appleby, Chief Economist at The King's Fund, looks at the good, the bad and the inexplicable of NHS health care variations alongside our new report.


  • 1. Variations in health care: The good, the bad and the inexplicable Maximising the good and minimising the bad in health care John Appleby Chief Economist, The Kings Fund April 2011

2. Figure 1: Mapping thecauses of variation 3. Figure 3: Distribution of crude rates and agegender standardised rates for primary hip replacement (English PCTs, 2009/10) 4. Figure 6: Agegender standardised ratios for selected elective procedures (2009/10), England=100 5. Figure 9: Variation over time: SCVs for hip replacement, cataract removal and tonsillectomy 2005/06, 2009/10 6.

  • Figure 11: Audit Commission basket of 25-daycase procedures, 2009/10 Per cent carried out as day cases by PCT,ordered on size ofcoefficient of variationlow = black medium = greyhigh = white

7. Figure 12: Measures ofvariation: selected loweffectiveness procedures,2009/10 8.

  • If all variation were bad, solutions would be easy. The difficulty is in reducing thebadvariation, which reflects the limits of professional knowledge and failures in its application, while preserving thegoodvariation that makes care patient-centred.
  • When we fail, we provide services to patients who dont need or wouldnt 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 Mulley Director of the Dartmouth Center for Health Care Delivery Science at Dartmouth College and Professor of Medicine at Dartmouth Medical School

9. Download the full report:



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