Regional Variations in the Use of Medical Services and the Accountability of the Profession

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Abstract
Elsewhere in this issue ofThe Journal1there appears yet another in a growing list of reports on variations in rates of utilization of health services or variations in medical practice patterns. The current report leaves something to be desired in its methodology, completeness of analysis, and some of the deductions derived from the authors' data. For example, while pointing out that differences in fertility rates completely explained the variation in the observed-to-expected rates of cesarean section, the authors then include 7,260 days of hospitalization for cesarean section in computing potential savings that might occur were such variations eliminated. It would seem equally illogical to add 6,324 days for reduction of fractured femurs unless the authors are proposing a safety program to prevent people from breaking their legs. These two items account for over 30% of the excess bed use cited. In a similar fashion, one might also question

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