What Do We Know and What Can Be Done to Improve Health System Performance?
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.
Whether or not a patient receives a particular health service depends to a great extent on the country in which he or she lives – and on the geographical area within a country. Wide variations in healthcare use exist across and within countries, but we still do not know whether high use is due to the provision of unnecessary procedures, or whether low use signals unmet need. Some of the very large geographic variations observed cannot be fully explained by differences in patient need or preferences. These unwarranted variations remain, signalling that health systems are not achieving the level of performance they could. Governments should step up efforts to ensure better use of health services.
The OECD publication was released at a joint conference organised by the OECD and the Bertelsmann Foundation on September 16, 2014. This event targeted German stakeholders to discuss geographic variations and where Germany stands in an international context.