Health policies and data

Medical Practice Variations


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 health care 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.


Release date:
16 September 2014

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Geographic Variations in Health Care
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.

> OECD press release: Governments must tackle regional variations in health care use, says OECD
> Read the Focus on Health: Geographic Variations in Health Care (PDF, 8 pages)
> Subscribers and readers at subscribing institutions can access the online edition via the OECD iLibrary
> Buy the publication on the Online Bookshop



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.

Visit for more information. The programme of the conference is available online.

> Read the press release in German: Rein medizinisch nicht erklärbar: In manchen Regionen wird acht Mal häufiger operiert als andernorts
> Read the chapter about Germany (in German): Deutschland: Geografische Variationen in der Gesundheitsversorgung



Country notes

Australia Australia Israel Israel
Belgium Belgium:
- in English
- in French
Italy Italy
Canada Canada:
- in English
- in French
Portugal Portugal
‌‌Czech-Republic Czech Republic Spain Spain
Finland Finland Switzerland  Switzerland:
- in English
- in French
France France:
- in English
- in French
United-Kingdom United Kingdom: England
Germany Germany  

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Additional material


Divya Srivastava (
Valérie Paris (
Gaetan Lafortune (
Annalisa Belloni (


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