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  1. R Mark Beattie, Editor-in-Chief

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Unwarranted variation in health care

We are all very aware that there is variation in health care across populations based on many factors including level of education, access, wealth and geographical location. The reasons for this variation are complex to analyse and some variation may be justifiable and necessary. Cheung et al discuss this important and topical issue in a narrative review. The authors look at variation in effective (or high value) care, for example uptake of immunisation, preference centred care where the optimal course of action is not always clear and supply sensitive care where health care utilisation is influenced by the availability of local resources. The authors highlight many examples using data from the recently published NHS Atlas of Variation ( which documents the rates of specific interventions by geographical location across England including, for example, a seven fold variation in admission rates for diabetic ketoacidosis and fivefold variation in rates of diagnostic endoscopy. This area of health care is ready for discussion and debate and information of this type is one of the many factors that should be taken into account when …

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