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Variation in the Delivery of Health Care: The Stakes Are High

David E. Wennberg, MD, MPH
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Maine Medical Center; Portland, ME 04102-3175 Requests for Reprints: David E. Wennberg, MD, MPH, Director, Division of Health Services Research, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102-3175.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(10):866-868. doi:10.7326/0003-4819-128-10-199805150-00012
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A generation ago, the remarkable variation in the delivery of health care across populations was brought to light [1]. Since then, numerous articles have documented variations across small and large areas of the United States in surgical procedures, health system capacity (such as physicians per capita), use of pharmaceuticals in chronic conditions, and intensity of diagnostic testing [26]. The principal finding of these studies has not changed: For medical care, geography is destiny.

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