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HL20: John E. Wennberg, MD—Variations in Care and the Constant Search for a Better Way

Joe Cantlupe, for HealthLeaders Media, December 13, 2012

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of John E. Wennberg, MD.

This profile was published in the December, 2012 issue of HealthLeaders magazine.

 "There's been a lot of progress: Not that there has been a substantial change in the variation problem, but there's been a lot better understanding of the causes of it, and the remedies we need to put into place to actually reduce variation."

While living in Vermont in the 1970s, John E. Wennberg, MD, MPH, was flabbergasted when his studies revealed that, in one area, children might have a 75% chance of their tonsils being removed, but if they lived 100 feet away, within the border of another school district, only 20% of the kids did.

Wennberg, founder of the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, N.H., has repeated this seminal story about his findings many times over the past 40 years about the variation of healthcare delivery, since it shaped his view of healthcare in America—and his life's work.

For "Jack" Wennberg, that research started a journey in which he has consistently criticized the health system for ordering too many unnecessary procedures and producing too much variation of healthcare across regions. These practices manifest themselves in results like uneven care for the chronically ill, or a national healthcare system that simply spends twice as much as it should. Wennberg's mantra has become indelibly stamped in healthcare: "More care doesn't mean better care."

For the white-haired, soft-spoken Wennberg, the data he has compiled and analyzed roars resoundingly throughout national debate on these matters.

From the outset, Wennberg saw that differences in U.S. healthcare spending were often the result of location. Among the more significant Dartmouth findings over the years has been the surprising discovery that, in some areas of the country, more aggressive care was the norm, and spending was twice at much. At the same time, he found that such spending did not necessarily improve outcomes.

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