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Andrew B. Bindman, MD

JAMA. 1999;281:2142-2143.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

More than 25 years ago, Wennberg and Gittelsohn¹ observed that communities in Vermont varied a great deal in the amount of health care they used. Many others have since duplicated these findings of variation in health care utilization across communities (ie, small-area variation). Wennberg and colleagues² concluded that small-area variation in health care utilization could not be attributed to how sick the population was who lived in various communities, nor to differences in their health outcomes, but rather to irrational physician decision making in the setting of uncertainty.

With time, policymakers in the United States who were struggling with rapidly escalating health care costs embraced these findings and interpreted them to mean that physicians were in part to blame. Health care policymakers and health plan administrators became concerned that they could no longer trust physicians to do the right thing and focused on developing tools that . . . [Full Text of this Article]

Author Affiliation: Primary Care Research Center Division of General Internal Medicine, San Francisco General Hospital, San Francisco, Calif.

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