Nearly forty years ago, the journal Science published an article that forever changed our approach to understanding health care delivery and spending trends in the United States. The authors, John Wennberg and Alan Gittelsohn, discovered for the first time that utilization of and spending on health care services varied markedly according to geographic area. Wennberg and Gittelsohn studied health services and delivery in the state of Vermont, where databases were available to provide the relevant claims and other data, and interpreted the small area variations as indicating differences in health care delivery practices among providers in the state. Subsequently, Wennberg and many other colleagues extended this variation analysis to the entire nation and demonstrated previously unappreciated differences in utilization, spending, and other aspects of health care services delivery across the United States. The data generated in the course of variation analyses were compiled into the Dartmouth Atlas of Health Care,1 a unique database that provides a treasure trove of information about regional variations in health care. The Dartmouth Atlas has been used by many researchers for over twenty years to generate new insights into diverse health care practices and to uncover health care delivery trends.
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