Salomeh Keyhani, M.D., M.P.H., Raphael Falk, M.D., M.P.H., Tara Bishop M.D., Elizabeth Howell M.D., and Deborah Korenstein, M.D.
S. Keyhani, R. Falk, T. Bishop et al., "The Relationship Between Geographic Variations and Overuse of Health Care Services: A Systematic Review," Medical Care, March 2012 50(3):257–61.
Some policymakers have sought to explain geographic variations in the receipt of health care as a function of either overuse or underuse of medical procedures and other services. One hypothesis holds that there may be overuse of care in regions or localities where there is a greater volume of services or health care costs are higher. In this Commonwealth Fund–supported study, researchers conducted a review of the professional literature to examine the relationship between geographic variations and overuse of health care services.
In a database search for articles published between 1978 and 2009, the authors found a total of five papers describing the relationship between geographic variations in care and "appropriateness" of care—defined as overuse, underuse, or both. For the few medical conditions studied, differences in rates of inappropriate care across geographic regions were only modest. While high-cost or high-intensity areas are thought by some to have higher rates of inappropriate care, the researchers found little clinical evidence to support or refute that assertion.
More clinical research examining is needed to improve our understanding of the relationship between overuse and underuse of health care and geographic variations in care.