This article examines some of the key research and policy issues that are emerging as a result of recent analyses of regional variations in health care. The article presents a historical background to this important new field of health services' research, and indicates, using some Danish examples of research on hysterectomy, cholecystectomy, and prostatectomy, the relevance of this research to management and policy planning. Regional variations are not yet fully explained in terms of what causes them. What is clear and what is the primary focus of this article is that their very existence, whatever their explanation, creates a major challenge for the management and planning of future health services.
In a questionnaire all urological units in Norway were asked about: 1. The examinations they routinely used for prostatism patients before deciding upon treatment. 2. How they would score different objective and subjective information about these patients on a scale from 0 to 10. 3. How the physicians classified different prostatism symptoms into categories of weak, moderate and severe. The results were: Urinary retention occurring more than once or residual urine greater than 500 ml was considered an absolute indication for surgery. Agreement about indications for surgery was good for information which received a high median score, but was much poorer for information which received a lower median score. Agreement on how to classify different symptoms into categories according to severity was not good. Using the median classification of symptoms it was estimated that urologists believe that 0.1-5.8% of men over 60 years of age have severe symptoms, 2.1-36.4% have moderate symptoms and 57.8-97.8% weak or no symptoms.