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.



Israel: Geographic variations in health care

Medical variations between geographical areas in Israel have been widely discussed in the last years, especially regarding accessibility to medical services in the periphery of the country. However, this is the first report that focusses on a selected set of hospital interventions and procedures. The interventions with the lowest variation across districts were hospital medical admissions, PTCA and surgery after hip fracture, while the highest variation was for knee arthroscopy, with a 4.5-fold variation between the districts with the lowest and the highest rate. Regarding cardiac revascularisation procedures, the trend over time in PTCA rates varied across districts, with PTCA rates increasing in some districts (the Northern and Southern districts) while decreasing in others. This trend is attributed to a vast investment in manpower and infrastructures in the periphery. More generally, one of the main findings of this report is that the Israeli periphery (the Northern district in particular) tends to have higher rates of hospital medical admissions and surgical activities for many of the procedures reviewed in this report. This phenomenon is not attributed to a specific policy and needs to be further investigated.


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