International Variations in a Selected Number of Surgical Procedures

This paper summarises recent international data on rates of five surgical procedures (i.e. caesarean,hysterectomy, prostatectomy, hip replacement and appendectomy) across OECD countries. It examinestrends over time and compares age- and sex-specific rates for a recent year, for a sub-set of countries forwhich data are available. The report shows substantial international variations for most procedures, butalso striking similarities between countries some procedures show universal trends, with trends in rates bysex and age behaving in very similar ways.A full understanding of the reasons for and consequences of different utilisation rates demands adetailed understanding of patterns of illness and patient preferences, incentives embedded within healthsystems, and above all mechanisms to link activity to outcomes. While recognising the many limitations ofthe data that exist, the analyses reported here paint a picture of widespread differences in the rates at whichcertain procedures are performed (e.g. hysterectomy and prostatectomy) yet, for others(e.g. appendectomy), they indicate the emergence of growing international convergence. It is important torecognise that these findings are simply a stimulus to further enquiry into health services. Where variationis observed, there is no way, using these data alone, of knowing which rate is the “right” one in anycountry. It is not even possible to say that the presence of variation is a sign of important health servicedelivery problems.      