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<h3>Objective.</h3> —To develop and test a method for comparing the appropriateness of hysterectomy use in different health plans. <h3>Design.</h3> —Retrospective cohort study. <h3>Setting.</h3> —Seven managed care organizations. <h3>Patients.</h3> —Random sample of all nonemergency, nononcological hysterectomies performed in the seven managed care organizations over a 1-year period. Patients who were not continuously enrolled in a plan for 2 years prior to their hysterectomy were excluded. <h3>Main Outcome Measures.</h3> —Proportion of women undergoing hysterectomy in each plan for inappropriate clinical reasons according to ratings derived from a panel of managed care physicians. <h3>Results.</h3> —Overall, about 16% of women underwent hysterectomy for reasons judged to be clinically inappropriate. Only one plan had significantly more hysterectomies rated inappropriate compared with the group mean (27%, unadjusted). Adjusting for age and race did not affect the rankings of the plans and had little effect on the numeric results. <h3>Conclusion.</h3> —The rates of inappropriate use of hysterectomies are similar to those for other procedures and vary to a small degree among health plans. This information may be useful to purchasers when they consider which health plans to offer their employees. (<i>JAMA</i>. 1993;269:2398-2402)