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In the current economic climate, OECD countries need now more than ever to make sure they spend money efficiently in the health sector. Reducing unwarranted variations in medical practice such as the possible overuse or underuse of particular health services may contribute to increasing quality, efficiency and equity in health care delivery. To investigate this possibility, the OECD has launched a project on variations in medical practice.

Aims

The OECD project on medical practice variations has three main aims:

a. Document medical practice variations, with a focus on within country variations;
b. Analyse possible causes of medical practice variations;
c. Explore policy options to reduce unwarranted variations and improve resource allocation.

Background

Medical practice varies both across and within countries, and the variation often does not seem to be related to differences in needs. These variations in medical practice include the possibility of overuse and underuse of certain health services, raising important policy implications regarding the quality, efficiency and equity in health service delivery.

Medical practice variations persist across and within countries. For instance:

• The probability of receiving a CT scan examination is almost four times higher in the United States than in the United Kingdom (OECD Health Data 2012). Within England, CT exam rates are however three times greater in certain primary care trusts than in others (NHS Atlas of variations in health care, 2011).
  
• The probability to get a coronary bypass or angioplasty is four to five times higher in Germany, Belgium and the United States than in the United Kingdom (OECD Health Data 2012). Within the United States, the rate of coronary bypass was five times greater in certain hospital referral regions than others between 2003 and 2007, while the rate of coronary angioplasty was up to ten times higher (Dartmouth Atlas, 2010).
  
• The percentage of caesarean sections is almost three times greater in Mexico and Italy compared with the Netherlands.  But within the Netherlands, the percentage of unplanned caesarean sections may vary by four times across hospitals (National Institute for Public Health and the Environment, 2010).
  

Variations in medical practice are not always bad. They can respond to differences in patient preferences and may also promote innovation in health care. Nevertheless, some medical practice variations raise serious issues about the quality, efficiency and equity in health care delivery.

The OECD project on medical practice variations was developed to gather recent evidence on the extent of variations in medical practice among the group of participating countries, to improve the understanding of the factors which explain these variations (including both supply-side factors and health system characteristics), and to identify possible policy levers to reduce unwarranted variations. 

Project management and timeline

The OECD project is supported by a group of experts from participating OECD countries, and will draw on collaboration with other international initiatives underway. This project began in the second half of 2011 and is expected to lead to an OECD report in the first half of 2014.

Contacts

Divya Srivastava (divya.srivastava@oecd.org)
Valérie Paris (valerie.paris@oecd.org)
Gaetan Lafortune (gaetan.lafortune@oecd.org)

Permanent URL: http://www.oecd.org/health/medicalpracticevariations

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Analytical Health Projects