Abstract
BackgroundBased on moderate quality evidence, routine pelvic examination is strongly recommended against in asymptomatic women. The aims of this study was to quantify the extent of routine pelvic examinations within specialized health care in Norway, to assess if the use of these services differs across hospital referral regions and to assess if the use of colposcopy and ultrasound differs with gynecologists’ payment models.MethodsNationwide cross-sectional study including all women aged 18 years and older in Norway in the years 2014–16 (2,038,747). Data was extracted from the Norwegian Patient Registry and Statistics Norway. The main outcome measures were 1. The number of appointments per 1000 women with a primary diagnosis of “Encounter for gynecological examination without complaint, suspected or reported diagnosis.” 2. The age-standardized number of these appointments per 1000 women in the 21 different hospital referral regions of Norway. 3. The use of colposcopy and ultrasound in routine pelvic examinations, provided by gynecologists with fixed salaries and gynecologists paid by a fee-for-service model.ResultsAnnually 22.2 out of every 1000 women in Norway had a routine pelvic examination, with variation across regions from 6.6 to 43.9 per 1000. Gynecologists with fixed salaries performed colposcopy in 1.6% and ultrasound in 74.5% of appointments. Corresponding numbers for fee-for-service gynecologists were 49.2% and 96.2%, respectively.ConclusionsRoutine pelvic examinations are widely performed in Norway. The variation across regions is extensive. Our results strongly indicate that fee-for-service payments for gynecologists skyrocket the use of colposcopy and increase the use of ultrasound in pelvic examinations of asymptomatic women.
Highlights
Based on moderate quality evidence, routine pelvic examination is strongly recommended against in asymptomatic women
Our results strongly indicate that fee-for-service payments for gynecologists skyrocket the use of colposcopy and increase the use of ultrasound in pelvic examinations of asymptomatic women
We quantified the extent of cervical screening tests within specialized health care in Norway, and we examined if differences across hospital referral regions in routine pelvic examinations were depended on differences in cervical screening tests
Summary
Based on moderate quality evidence, routine pelvic examination is strongly recommended against in asymptomatic women. The aims of this study was to quantify the extent of routine pelvic examinations within specialized health care in Norway, to assess if the use of these services differs across hospital referral regions and to assess if the use of colposcopy and ultrasound differs with gynecologists’ payment models. Based on moderate quality evidence, routine pelvic examination is strongly recommended against in asymptomatic women [1,2,3], as is screening colposcopy [4] and routine screening for ovarian cancer in asymptomatic women [5,6,7]. All citizens have a legal right to equal access to good quality health care [14]. Apart from abortions, women themselves cannot make an appointment at a publicly reimbursed gynecologist without a referral
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