- Despite forty years of the NHS, there are continuing geographical variations in the provision, use and outcome of health services. These variations are manifested in the greater availability of doctors and hospital beds in some areas than others; differences in the use made of these doctor and beds; and variations in the outcomes associated with the use of services. Awareness of these variations has resulted in action by policy makers on three main fronts. Since the early 1970s the DHSS has sought to reduce variations in the allocation of health care resources by basing allocations on the needs of each area. During the 1980s there has been increasing interest among policy makers in variations in the use of resources, exemplified by the development of performance indicators which draw on routine statistics to compare the performance of health authorities. Policy makers have shown an interest in the outcomes associated with health services, including geographical variations in outcomes, although interest in health service variations has not been confined to policy makers. This report represents a range of material on different aspects of variations, and focusses on hospital utilisation rates. The report draws on a diverse literature scattered through specialist journals and publications. This literature is not readily accessible to researchers or policy makers. The report therefore offers a review and commentary on the literature in an attempt to summarise the current state of research and analysis. It also seeks to draw out the implications of what is known about variations in utilisation rates for policy makers and researchers.