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.



Canada: Geographic variations in health care

In Canada, there continues to be large variations in medical practice across provinces and territories as well as across health regions in each province, raising questions about the efficiency and equity of health service delivery. This chapter focusses on the use of nine health care activities and procedures between 2003 and 2010. Hospital medical admissions have generally declined in Canada and are low compared with other OECD countries, but there remain substantial variations across provinces (nearly two-fold difference) and health regions (nearly four-fold difference). Knee replacement surgery has increased in all provinces since 2003, with no reduction in the large variations across provinces and health regions. This contrasts with coronary angioplasty, which has also increased in all provinces, but more so in provinces that started with a low level in 2003, indicating a certain degree of convergence in the treatment of people following heart attack. There has also been a strong rise in the use of MRI and CT scans, but despite some reduction in the variation in MRI exams across provinces, substantial variation remains (nearly two-fold difference). In 2013, the Canadian Medical Association, in co-operation with some universities and patient groups, adapted the Choosing Wisely campaign initially developed in the United States to promote more informed discussions between doctors and patients and to reduce unnecessary diagnostic tests and procedures. The impact of this new initiative should be closely monitored.


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