Geographical variation in radiological services: a nationwide survey

Kristin Bakke Lysdahl,Ingelin Børretzen

doi:10.1186/1472-6963-7-21

Abstract

BackgroundGeographical variation in health care services challenges the basic principle of fair allocation of health care resources. This study aimed to investigate geographical variation in the use of X-ray, CT, MRI and Ultrasound examinations in Norway, the contribution from public and private institutions, and the impact of accessibility and socioeconomic factors on variation in examination rates.MethodsA nationwide survey of activity in all radiological institutions for the year 2002 was used to compare the rates per thousand of examinations in the counties. The data format was files/printouts where the examinations were recorded according to a code system.ResultsOverall rates per thousand of radiological examinations varied by a factor of 2.4. The use of MRI varied from 170 to 2, and CT from 216 to 56 examinations per 1000 inhabitants. Single MRI examinations (knee, cervical spine and head/brain) ranged high in variation, as did certain other spine examinations. For examination of specific organs, the counties' use of one modality was positively correlated with the use of other modalities. Private institutions accounted for 28% of all examinations, and tended towards performing a higher proportion of single examinations with high variability. Indicators of accessibility correlated positively to variation in examination rates, partly due to the figures from the county of Oslo. Correlations between examination rates and socioeconomic factors were also highly influenced by the figures from this county.ConclusionThe counties use of radiological services varied substantially, especially CT and MRI examinations. A likely cause of the variation is differences in accessibility. The coexistence of public and private institutions may be a source of variability, along with socioeconomic factors. The findings represent a challenge to the objective of equality in access to health care services, and indicate a potential for better allocation of overall health care resources.Previous publicationThe data applied in this article was originally published in Norwegian in: Børretzen I, Lysdahl KB, Olerud HM: Radiologi i Noreg – undersøkingsfrekvens per 2002, tidstrendar, geografisk variasjon og befolkningsdose. StrålevernRapport 2006:6. Østerås: The Norwegian Radiation Protection Authority. The Norwegian Radiation Protection Authority has given the authors permission to republish the data.

Highlights

Geographical variation in health care services challenges the basic principle of fair allocation of health care resources
In Norway the health care system is predominantly public, and the National Insurance Scheme covers the vast majority of radiology services, that is when patients obtain a referral from their physician (GP or specialist)
Geographical variation in the use of different modalities is shown in Table 1, in terms of examination rates

Summary

Introduction

Geographical variation in health care services challenges the basic principle of fair allocation of health care resources. To determine the presence and magnitude of variability of radiology is important with respect to the question of equal access to health care, which is a declared objective in Norwegian health policy (as in most other countries), and stated in The Patients' Rights Act [7]. Such data is valuable with respect to the question of allocation of overall health care resources, especially as radiology is a costly discipline, and expenditure on radiology is steadily increasing [8]. The question of the correct or reasonable level of utilization cannot be answered through small area variation analysis, a significant variation in otherwise homogeneous areas may indicate that use of radiological services, at least in some areas, is not optimal [2,5]; that is, that underuse or overuse occurs

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