Faculty Opinions recommendation of Small Area Variations in Health Care Delivery: A population-based health information system can guide planning and regulatory decision-making.

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Abstract
This exceptional article, published 40 years ago, showed that non-medical factors play a decisive role in the geographically unequal distribution of health services. It opened a new perspective for the analysis and evaluation of health care, questioned the paternalistic concept of delegated decision-making, and gave the reasons for the necessity of evidence-based shared decision-making – a concept that Wennberg, in his then future work, consequently developed. Wennberg and Gittelsohn analysed data from different sources and found regional variations of medical practice that could not be explained medically. This study was, as Wennberg puts it, the starting point of his “intellectual journey to deal with fundamental contradictions in the patterns of medical practice” {1}, a journey that still goes on. Wennberg later described care as effective, supply-sensitive and preference-sensitive, and he showed that decisions about preference-sensitive care cannot meaningfully be delegated to the physician and opened the way for shared decision-making. The findings of this and further studies were not really appreciated by the profession then but are more influential now than ever.

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