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.



Germany: Geographic variations in health care

This report documents geographic variations in health care use in Germany, for a number of hospital-based activities (medical admissions, caesarean sections, coronary procedures, knee replacements and hysterectomies), across Länder and across Spatial Planning Regions. It complements information from other contemporary work. Although possible explanations for variation beyond demographics are drawn from existing research (e.g. need and supply-side factors), a substantial amount of variation is still unexplained and thus possibly unwarranted, given current knowledge. It is therefore recommended that research should continue, alongside the engagement of stakeholders, including those responsible for health care decision making in various contexts. In particular it is recommended that sustained efforts be undertaken to strengthen the evidence base regarding the appropriateness of interventions, thus providing more reliable information for necessary discussions between payers/purchasers, providers and patients. Considerable effort going beyond a more sophisticated analysis of variation is therefore needed to promote evidence-based changes that would either reduce variation or inspire trust that variation in health care use is warranted because it reflects patient needs and has health benefits.


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