Abstract
BackgroundMedical practice variation refers to differences in health service utilization among regions in the same country. It is used as a tool for studying health inequities.In 2011, the OECD launched a Medical Practice Variation Project which examines regional differences within countries and explores the sources of the inter-regional differences. The aim of this study is to examine the patterns and trends in geographic variation for selected health services in Israel.MethodsThe analysis is based on data from the National Hospital Discharges Database (NHDD) of the Israeli Ministry of Health. The eight procedures and services studied were: medical admissions (i.e. admissions without surgical procedures); hip fractures; caesarian sections; diagnostic cardiac catheterization; cardiac angioplasty (PTCA); cardiac bypass surgery (CABG); hysterectomy; and knee replacement surgery. The data are presented for the 7 districts in Israel, determined by address of residence.ResultsThe procedures and services with the lowest variation across the seven districts were medical admissions (RR between regions-maximum/minimum 1.3) and hip fractures (RR 1.44), while the one with the highest variation was CABG (RR 1.98). The Israeli periphery, and the northern district in particular, had higher rates of medical admissions, knee replacement and cardiac procedures. When studying the trend over time, we found a decrease in use rates for most procedures, such as coronary bypass (R. 04) and CABG (R 0.8). Medical admissions decreased by 8%, with the highest decline (16%) observed in the central districts.ConclusionsThis study provides Israeli policy makers with information which is vital for the strategic planning of service development, such as strengthening preventive medical services in the community, reducing cardiovascular risk factors in the periphery and expanding the national publication of clinical quality scores.
Highlights
Medical practice variation refers to differences in health service utilization among regions in the same country
The data presented in this study are based on the National Hospital Discharges Database (NHDD) maintained by the Health Information Division in Israel’s Ministry of Health
Variation was highest for coronary bypass, with an rate ratio (RR) of 2.0 between the highest and lowest regional rates, and knee joint replacement surgery with a RR of 1.8
Summary
Medical practice variation refers to differences in health service utilization among regions in the same country. The aim of this study is to examine the patterns and trends in geographic variation for selected health services in Israel. The first research group in this field published its work in what later developed to be known as “medical practice variation studies” or “small area analysis” and it was the first to demonstrate differences in the supply of health services between geographic regions in the U.S The conclusions of this team were first published in 1973 and showed great differences in the consumption and supply of medical services between neighboring regions within the state of Vermont [1]. The OECD used this tool in 2011 for the “Medical Practice Variations” project which aims to examine regional differences within countries [2].
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