ABSTRACT
This chapter analyses the framework for understanding the health of populations. It argues that framework was used to explicate the role of particular factors such as genetics, social class, and culture. The variation in patterns of medical practice may be largely caused by uncertainty. Marked differences in the practice patterns of individual physicians seem to have produced the variation in rates. Some of the most persuasive evidence of the impact of practice style comes from the work on "surgical signatures." Manitoba elderly patients reporting good or excellent health were found to have very different probabilities of being hospitalized in the two years after their interview, depending upon the practice style of their physician. Some physicians can be very hesitant to change established practice patterns, even where improved quality of care is directly involved. Cases identified using the discharge abstracts were more likely to have quality of care problems than were those chosen at random.
