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Appropriateness of care: why so much variation

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Broad descriptions of variation are a useful way of finding disparities, but to generate change they need to be carefully analysed and applied

The Supplement accompanying this issue of the MJA addresses variation in health care delivery as an important theme in ensuring appropriate care across the health system. While all would agree that health care should be provided as and where needed, and that only appropriate care should be delivered, difficulties arise when seeking consensus on what variation is “appropriate” and what should be done about it.

Complex systems are inherently variable. Indeed, a multitude of data shows variation in clinical practice but there is less consensus on its implications. For example, while one focus is high utilisation, there is also an issue with underutilisation, raising issues of equity. Aboriginal and Torres Strait Islander people receive fewer interventions for a range of major health conditions than non-Indigenous Australians; the age standardised rate of coronary procedures is 40% lower.1 Overall, the lowest quintile by socio-economic status of area of residence has 78.8 elective hospital admissions involving elective surgery per 1000 population compared with 91.5 for the highest quintile.2

Geographic variation is the focus of the recent Australian Atlas of Health Care Variation,