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Geographic Variations in Health Care

What Do We Know and What Can Be Done to Improve Health System Performance?

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Variations in health care use within a country are complicated. In some cases they may reflect differences in health needs, in patient preferences or in the diffusion of a therapeutic innovation; in others they may not. There is evidence that some of the observed variations are unwarranted, signalling under- or over-provision of health services, or both. This study documents geographic variations for high-cost and high-volume procedures in select OECD countries. It finds that there are wide variations not only across countries, but within them as well. A mix of patient preferences and physician practice styles likely play an important part in this, but what part of the observed variations reflects over-provision, or whether there are unmet needs, remain largely unexplained. This report helps policy makers better understand the issues and challenges around geographic variations in health care provision and considers the policy options.

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Belgium: Geographic variations in health care

This chapter looks at variations in medical practice across provinces in Belgium, for hospital medical admissions and a number of diagnostic and surgical procedures, drawing on data from 2009. While variations across provinces are relatively small for hospital admissions and some surgical procedures such as caesarean sections, variations are larger in the use of diagnostic procedures such as knee arthroscopy, cardiac catheterisation, MRI exams and CT exams.

In the case of MRI and CT exams, there is strong evidence of a “substitution” effect in the use of these two diagnostic exams. Furthermore, differences in utilisation rates are due at least partly to a greater number of MRI units in the Flemish provinces. A strategy involving co-operation with stakeholders was developed to reduce exposure to ionising radiation from imaging tests by 25%.

Persisting geographic variations in medical practice in Belgium requires a variety of strategies and approaches to engage governments, providers and patients in continuously improving health service delivery.

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