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.



France: Geographic variations in health care

In France, awareness about practice variations has been growing in recent years due to the harsh economic context and changes in regional governance. This chapter provides information on variations in the use of eight specific hospital procedures and activities across departments for 2005 and 2011. It then provides an overview of the major policy instruments used in France for tackling variations in medical practice.

The results confirm systematic variations between departments in the hospitalisation rates that are difficult to justify simply by the differences in local populations. The relative magnitude of the variations observed by procedure is coherent with the literature: it is highest in revascularisation and knee procedures and lowest for surgery after hip fracture. Cross-departmental variations for most procedures decreased between 2005 and 2011. Further work is called for to develop a better understanding of the causes and consequences of these variations in different types of care and to determine the margins for improvement in terms of equity, quality and efficiency.


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