OECD’s report on Geographic Variations in Health Care analyses the geographic variations across a range of high-volume and high-cost health care activities, such as heart bypass or knee replacement operations.
Some of the variations observed in the 13 OECD countries are unwarranted, says the report, and ought to be tackled so that high-quality health systems deliver the care patients need.
The number of patients admitted to a hospital for a reason other than surgery, for example, is twice as high in Australia, Germany and Israel than in Canada, Portugal and Spain. Admission rates also vary widely within countries: in some parts of Australia, Canada, England, Finland, Italy or Portugal, a patient is two to three times more likely to be admitted to hospital than in other parts of those countries.
A patient is also three times more likely to undergo cardiac revascularisation procedures in Germany and Israel than in countries with the lowest levels of intervention. In most countries, these procedures have the highest level of variation across geographical areas. Knee replacement rates vary by more than five-fold within Canada, Portugal and Spain, and by two-to three-fold across geographic areas in most OECD countries.
Caesarean section rates are on the rise. The probability to give birth by C-section is 50% higher in Italy, Portugal, Australia, Switzerland and Germany than in the other participating countries. C-section rates vary little within countries, except in Italy where they vary by six-fold across provinces.
To tackle unwarranted variations in health care use, governments should put in place:
- Public reporting and target setting. Canada, the Netherlands, Spain, and the United Kingdom have public reporting on health care utilisation by geographic area. Italy sets regional targets to encourage more appropriate use of caesarean sections, and Belgium sets targets for reducing exposure to radiation from imaging tests.
- Policies targeting providers. Providers receive feedbackon utilisation ofcardiac care in Ontario (Canada) and caesarean sections in Belgium. Spain has a monitoring system to support compliance with clinical guidelines for C-sections and financial incentives show some promise in England, France and Korea.
- Patient centred approaches. Tools to support shared patient doctor decision-making are used in the United States and the United Kingdom. Patient outcome measurement after surgical procedures is used in Sweden and the United Kingdom to indicate to what extent patients have benefitted from the intervention or not.