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.



Finland: Geographic variations in health care

This chapter describes geographic variations in the rates of medical admissions to hospitals and in eight surgical procedures performed for 20 hospital districts over the period 2001 to 2011. While medical admission rates decreased by over 20% and hysterectomy rates by over 40% over this period, knee replacements increased by 80% and coronary revascularisations by 30%. These changes obviously reflect the trends in developing treatments and care.

There were also changes in the extent of geographic variation in hospital use, such as a decrease in variations of knee interventions and an increase in variations for coronary revascularisations. These trends may be associated with several factors, such as differences in resource development and the adoption of new practices, but also with policy measures adopted (for instance for hysterectomy and knee interventions).

In Finland, several measures have already been introduced to tackle practice variations, such as the establishment of comprehensive health care registers, the production of performance indicators, and the development of national clinical guidelines and common criteria for treatments. More systematic implementation and monitoring of these measures may be needed.


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