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.



Italy: Geographic variations in health care

This chapter outlines variations for nine health care activities and procedures carried out in Italy for the timeframe 2007-11. During the study period, national and median provincial rates declined for almost all procedures, except for caesarean rates and knee replacements. The coefficient of variation remained generally stable, with the exception of a decrease in hospital medical admissions and increase in catheterisation and knee arthroscopy. However, the gap between the highest and lowest rates, except for hospital medical admissions, generally widened, showing that extreme values are still present and shall raise the concern of policy makers. The increased implementation of programmes on quality monitoring (National Outcomes Programme, Griglia LEA) and efficiency (Recovery Plans) may have contributed to the steady reduction in overall rates, such as the declining caesarean section rates observed in southern regions in 2012. However, targeted action is still needed to reduce the high level of variation found to persist across the country.


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