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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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Czech Republic: Geographic variations in health care

This chapter gives an overview of geographic variations in the Czech Republic for hospital medical admissions, caesarean section, knee replacement, hip replacement, and hysterectomy. Age- and gender-standardised rates of utilisation are reported for the 14 regions and the 77 former districts, in 2011.

While the number of caesarean sections and knee and hip replacements is increasing, the number of hysterectomies is gradually declining. Geographic variations are particularly high for hysterectomy and, to a lesser extent for knee replacement. Regions do not constantly show a low or high prevalence for all health care interventions. Prague has a high prevalence of caesarean sections but low prevalence of knee and hip replacements and hysterectomies. Regions with a lower socioeconomic profile have heterogeneous patterns. While Northwest Bohemia has a low prevalence of caesarean sections, North Moravia has the highest rate. At the district level, high prevalence of gynaecological procedures (caesarean section or hysterectomy) in some areas cannot fully be explained by patient preferences and provider motivations require further investigation.

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