Geographic variations in the use of services: do they have any clinical significance?

Prologue: The primary role that private physicians have played in the design of government efforts to moderate the cost of medical care has been to take exception to the public intrusions into their professional world. Such railing, be it in the name of concern for patients, social equity, quality of care, professional freedom, or the vaunted reputation of American medicine is simply not enough. That, at least, is the strong message of Robert Brook and his colleagues at the Rand Corporation. Because physicians have not aggressively engaged the problem of constraining society's investment in medical care, the government's proposed solutions have been largely economically based; that is to say, they have sought to constrain rates of increase in the cost of services rather than identifying the most efficacious care and paying for it, and refusing to reimburse for treatments found ineffective. Brook and his colleagues say that physicians must undertake the close self-examination necessary to propose better al...