This report documents geographic variations in health care use in Germany, for a number of hospital-based activities (medical admissions, caesarean sections, coronary procedures, knee replacements and hysterectomies), across Länder and across Spatial Planning Regions. It complements information from other contemporary work. Although possible explanations for variation beyond demographics are drawn from existing research (e.g. need and supply-side factors), a substantial amount of variation is still unexplained and thus possibly unwarranted, given current knowledge. It is therefore recommended that research should continue, alongside the engagement of stakeholders, including those responsible for health care decision making in various contexts. In particular it is recommended that sustained efforts be undertaken to strengthen the evidence base regarding the appropriateness of interventions, thus providing more reliable information for necessary discussions between payers/purchasers, providers and patients. Considerable effort going beyond a more sophisticated analysis of variation is therefore needed to promote evidence-based changes that would either reduce variation or inspire trust that variation in health care use is warranted because it reflects patient needs and has health benefits.