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The Global Role of Health Care Delivery Science: Learning from Variation to Build Health Systems that Avoid Waste and Harm

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ABSTRACT

This paper addresses the fourth theme of the Indiana Global Health Research Working Conference, Clinical Effectiveness and Health Systems Research. It explores geographic variation in health care delivery and health outcomes as a source of learning how to achieve better health outcomes at lower cost. It focuses particularly on the relationship between investments made in capacities to deliver different health care services to a population and the value thereby created by that care for individual patients. The framing begins with the dramatic variation in per capita health care expenditures across the nations of the world, which is largely explained by variations in national wealth. The 1978 Declaration of Alma Ata is briefly noted as a response to such inequities with great promise that has not as yet been realized. This failure to realize the promise of Alma Ata grows in significance with the increasing momentum for universal health coverage that is emerging in the current global debate about post-2015 development goals. Drawing upon work done at Dartmouth over more than three decades, the framing then turns to within-country variations in per capita expenditures, utilization of different services, and health outcomes. A case is made for greater attention to the question of value by bringing better information to bear at both the population and individual levels. Specific opportunities to identify and reduce waste in health care, and the harm that is so often associated with it, are identified by learning from outcome variations and practice variations.

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Acknowledgements

This paper is based on a keynote address given at the Indiana Global Health Research Working Conference on October 5, 2012. The author thanks Thomas Inui, William Tierney, and Jeffrey Jackson for their roles in the development of the conference and this special issue of JGIM and for reviewing drafts of my address and this paper.

Conflicts of Interest

AGM is senior clinical adviser to the Informed Medical Decisions Foundation and receives consulting fees for decision aid content and design. He also receives royalties from Health Dialog, which distributes decision aids and other forms of decision support developed in collaboration with the Foundation.

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  1. The Dartmouth Center for Health Care Delivery Science and The Geisel School of Medicine at Dartmouth College, HB 7256 37 Dewey Field Road, 2nd Floor, Hanover, NH, 03755, USA

    Albert G. Mulley Jr. MD, MPP

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Correspondence to Albert G. Mulley Jr. MD, MPP.

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Mulley, A.G. The Global Role of Health Care Delivery Science: Learning from Variation to Build Health Systems that Avoid Waste and Harm. J GEN INTERN MED 28 (Suppl 3), 646–653 (2013). https://doi.org/10.1007/s11606-013-2457-6

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