Stano M
School of Business Administration, Oakland University, Rochester, MI 48309.
Health Policy. 1993 Apr;24(1):9-17. doi: 10.1016/0168-8510(93)90084-3.
The primary purpose of this article is to develop a framework for reinterpreting the role of physician practice style in the small area variations phenomenon. This phenomenon deals with the wide interarea variations in per capita use rates which have been found for many medical and surgical procedures. The variations have been interpreted by many to suggest that large amounts of unnecessary care are being provided. The variations and corresponding perceptions of unnecessary care have also led to a US health policy which is increasingly emphasizing patient outcomes research. I show, however, that most of the empirical studies of the variations phenomenon have inappropriately aggregated either across procedures or across market areas so as to obscure the role of practice style. Its role has also been obscured by the common failure to distinguish practice style from other determinants of utilization. As a result, small area methods can lead to substantial error in identifying procedures associated either with major differences in practice style or with substantial amounts of unnecessary care if all variation is attributed to practice style.
本文的主要目的是构建一个框架，用于重新诠释医生执业风格在小区域差异现象中的作用。这种现象涉及到许多医疗和外科手术中人均使用率存在的广泛区域间差异。许多人将这些差异解读为表明存在大量不必要的医疗服务。这些差异以及对不必要医疗服务的相应认知，还催生了一项日益强调患者预后研究的美国卫生政策。然而，我指出，大多数关于差异现象的实证研究在程序或市场区域上进行了不恰当的汇总，从而模糊了执业风格的作用。由于普遍未能将执业风格与其他利用决定因素区分开来，其作用也被掩盖了。因此，如果将所有差异都归因于执业风格，小区域方法在识别与执业风格的重大差异或大量不必要医疗服务相关的程序时可能会导致重大误差。
