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.



Switzerland: Geographic variations in health care

This report presents the inter-cantonal differences between rates of utilisation of certain medical services in Switzerland. The analysis focuses on six procedures performed on an inpatient basis (caesarean section, coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA), cardiac catheterisation, knee replacement and knee arthroscopy) and two types of admission (medical hospital admission and admission for hip fracture) between 2005 and 2011. Cardiac procedures rates seem to converge over the years. With regard to knee arthroscopies the type of care (ambulatory/inpatient) varies from canton to canton, and the rates of utilisation of inpatient care for this medical practice differ to a certain extent. Lastly, the rates for the other procedures and the remaining two types of admission were already fairly close in 2005 and have remained so throughout the period of analysis.


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