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The variation phenomenon in 1994.

Fifty years of scholarship have established the existence and importance of the variation phenomenon in modern medicine -- the observation of differences in the way apparently similar patients are treated from one health care setting to another. Recent experience also suggests that the response to this phenomenon has the potential for both great good and great harm as health care reform continues to unfold. The contribution by Fisher and his colleagues in this issue of the Journal1 is only the latest of many studies from the groups at Dartmouth, the Rand Corporation, and elsewhere that have confirmed beyond any reasonable . . .