[Differences in the use of health care services--is everything unethical?].
BACKGROUND
Regional differences in the use of health services have been known for several decades. This variability is often overall regarded as undesirable in discussions and ethical-moral argumentation takes place. The description and analysis of this variability and the underlying causes are the subject of numerous investigations in various health care systems.


OBJECTIVE
The purpose of this research was to determine which causes can the current health care situation be attributed to and which approaches exist to counteract undesirable variability.


METHODS
On the basis of a selective literature search, an overview on the identification of variations in surgical care as well as a presentation of possible causes and solution approaches were created.


RESULTS
Numerous factors influencing the decision-making process regarding surgical interventions could be identified. These can be patient-related, disease-/intervention-related, physician-related, or system-related and are partially linked with each other. The optimal strategies to minimize variability in health care are still unclear. Scientific evidence to assess the benefit and risk of an intervention, physician's attitudes and preferences as well as the involvement of patients in the decision-making process, however, seem to be important starting points.


CONCLUSIONS
The description of regional differences is an important step toward provision of evidence-based and tailored health care. Differences in health care provision and especially regionally varying high intervention rates are not per se problematic. Whether a patient receives an intervention or not should, however, not depend any more on where he or she lives and which physician is being consulted, but on his or her individual medical condition or preferences. Target group-oriented evidence-based information can help to minimize undesirable variability.
IFOM - Institut für Forschung in der Operativen Medizin, Abteilung für Evidenzbasierte Versorgungsforschung, Lehrstuhl für Chirurgische Forschung, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten/Herdecke, Ostmerheimer Straße 200, Haus 38, 51109, Köln, Deutschland, michaela.eikermann@uni-wh.de.
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D005858:Germany / Q000453:epidemiology; D006297:Health Services Accessibility / Q000941:ethics* / Q000706:statistics & numerical data*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000941:ethics* / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000941:ethics* / Q000706:statistics & numerical data*