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.



United Kingdom (England): Geographic variations in health care

This chapter presents data on geographic variations in England for hospital medical admissions and a number of surgical and diagnostic procedures (caesarean sections, revascularisation procedures, knee replacements, admission after hip fracture, and CT and MRI scans) based on the ten Strategic Health Authorities and 151 Primary Care Trusts that were in place in 2010-11. As expected, admission after hip fracture has the lowest rate of regional variation, as there is little discretion to operate a patient following a hip fracture. The highest degree of regional variations are for coronary artery bypass grafts, knee replacement and MRI scans, interventions for which there is a higher degree of physician discretion and also possibly regional variations in the capacity to deliver these procedures. Since 2009, the English NHS has started to monitor patient outcomes following knee replacement and other surgical interventions such as hip replacement to assess health improvements before and after the operations. These Patient Reported Outcome Measures (PROMs) show that the vast majority of patients who had a knee replacement in 2010-11 reported positive outcomes following their operation, both in regions with high rates and low rates of knee replacement.


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