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.



Spain: Geographic variations in health care

This chapter outlines geographic variations in Spain at the provincial and regional levels in the period 2000-10. Hospital admission rates remained stable over time and across regions, with relatively little geographic variation. While caesarean section rates increased in Spain up to 2005, and then decreased, greater variation is observed at the province level. Caeserean section rates have continued to rise in private hospitals, while the trend has been reversed in public hospitals. The overall rates of hysterectomy and the variation across regions decreased during the study period. Cardiovascular procedures (CABG, PTCA and catheterisation) show great variations between provinces, although the variations have decreased over time for PTCA. The number of joint procedures increased over time, with great variation, particularly for knee arthroscopies and knee replacements. As expected, variations across regions have been lower and more stable for surgery after hip fracture. The recent experience in reducing caesarean section rates in many public hospitals provides a good example of the possibility of reducing the overuse of certain interventions through the development and implementation of clinical guidelines in a way that involves all key stakeholders. Nevertheless, the challenge remains to extend this approach to all regions and hospitals.


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