Getting the most benefit from the variations research: next steps.

In this response, I acknowledge the valuable contribution made by John Wennberg and colleagues in describing the variations in use rates. I caution against reaching certain conclusions based on the limitations of the data, and I offer suggested next steps to optimize the benefit to be gained from the study.

The erosion of health insurance: the unintended consequences of tiered products by health plans.

When properly structured, consumer-driven health care may provide gains to both patients and the delivery system. However, the current approach by health plans could result in real harm to patients and to an already fragile health care delivery system. While health plans are presenting tiered products as a necessary mechanism to control rising hospital expenditures, this paper explores the real drivers of the rising cost of health care, including utilization, increased demand for advanced medication, and new technology.