A systematic review of medical practice variation in OECD countries

Corallo, Ashley N.; Croxford, Ruth; Goodman, David C.; Bryan, Elisabeth L.; Srivastava, Divya; Stukel, Thérèse A.

doi:10.1016/j.healthpol.2013.08.002

Cited by 251 publications

(237 citation statements)

References 64 publications

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“…50 A recent systematic review identified large differences in the volume of healthcare between countries, regions, hospitals as well as individual healthcare providers. 51 This may be caused by potential shortfalls in 3 areas: underuse of effective care, misuse in preference-sensitive care, and overuse of supplysensitive care. Several remedies have been described to reduce unwarranted variation, such as the implementation of clinical practice guidelines to stimulate evidence-based practice, increasing the role of patients in shared decision-making to optimize preference-sensitive care, and regulating resource capacity in the healthcare system to reduce supply-sensitive care.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between the Scope of Essential Health Benefits and Statutory Financing: An International Comparison Across Eight European Countries

Wees

Wammes

Westert

et al. 2015

Int J Health Policy Manag

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Background: Both rising healthcare costs and the global financial crisis have fueled a search for policy tools in order to avoid unsustainable future financing of essential health benefits. The scope of essential health benefits (the range of services covered) and depth of coverage (the proportion of costs of the covered benefits that is covered publicly) are corresponding variables in determining the benefits package. We hypothesized that a more comprehensive health benefit package may increase user costsharing charges. Methods: We conducted a desktop research study to assess the interrelationship between the scope of covered health benefits and the height of statutory spending in a sample of 8 European countries: Belgium, England, France, Germany, the Netherlands, Scotland, Sweden, and Switzerland. We conducted a targeted literature search to identify characteristics of the healthcare systems in our sample of countries. We analyzed similarities and differences based on the dimensions of publicly financed healthcare as published by the European Observatory on Health Care Systems. Results: We found that the scope of services is comparable and comprehensive across our sample, with only marginal differences. Cost-sharing arrangements show the most variation. In general, we found no direct interrelationship in this sample between the ranges of services covered in the health benefits package and the height of public spending on healthcare. With regard to specific services (dental care, physical therapy), we found indications of an association between coverage of services and cost-sharing arrangements. Strong variations in the volume and price of healthcare services between the 8 countries were found for services with large practice variations. Conclusion: Although reducing the scope of the benefit package as well as increasing user charges may contribute to the financial sustainability of healthcare, variations in the volume and price of care seem to have a much larger impact on financial sustainability. Policy-makers should focus on a variety of measures within an integrated approach. There is no silver bullet for addressing the sustainability of healthcare. Implications for policy makers• Reduction of the scope of the benefit package and an increase of user charges has limited impact on the reduction of the volume and cost of care at the macro level. Supply constraints may have a much larger impact on reducing the volume of care and thus the long-term financial sustainability of public healthcare provision. • Policy-makers should focus on a variety of measures within an integrated approach, including considerations for services covered, costsharing arrangements, stimulating evidence-based practice, the monitoring and reduction of unwarranted variation, and control mechanisms for the price of healthcare services. Implications for publicCoverage for healthcare services funded by public revenues in our sample of 8 European countries is comparable and comprehensive, with only marginal differences. It is the c...

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Section: Discussionmentioning

confidence: 99%

The Relationship Between the Scope of Essential Health Benefits and Statutory Financing: An International Comparison Across Eight European Countries

Wees

Wammes

Westert

et al. 2015

Int J Health Policy Manag

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“…In the US substantial geographic variation in utilization of services has been attributed to a feefor-service based reimbursement system that incentivizes over-utilization, lack of use of informed patient decisionmaking, and lack of consensus around acceptable practices [1][2][3][4]. Explanation of geographic variation in a variety of healthcare services in other OECD countries has been inconsistent [5]. However, France has been found to demonstrate less geographic variation than the US or UK in per-capita utilization rates of common elective surgical procedures [6]; the lower variation was attributed, in part, to greater centralized planning of hospital capacity in France.…”

Section: Introductionmentioning

confidence: 99%

Rates of admission for ambulatory care sensitive conditions in France in 2009–2010: trends, geographic variation, costs, and an international comparison

2015

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“…Compared to control by management or to market incentives peer control is probably weaker and allows more deviance. For example, medical literature has always documented large and irrational variations in medical practice across regions, hospitals and physician practices for almost every condition and procedure [16]. Self-regulation by professional communities is sometimes considered an inefficient result of power dynamics among professional groups and the wider society.…”

Section: Professional Control Professional Development and Non-hieramentioning

confidence: 99%

Using IT for Non-Hierarchical Performance Assessment: New Ways to Develop Professionals in Health Care

Fabio¹

2015

JHRM

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Abstract:The aim of this article is to describe how technological innovations are being used to address the specific challenges of assessing health care professionals' performance and to discuss the theoretical implications of these innovations for human resources management. Performance management is specifically challenging for organizations employing skilled professionals, such as physicians, due to the complexity in defining performance and to the autonomy that professionals enjoy. Professionalism of employees implies that supervisors cannot evaluate adequately their subordinates' performance and, thus, alternative assessment systems are necessary. This explains why in health care schemes such as 360-degree feedback and peer review are increasingly used. We define these alternative assessment systems as "non-hierarchical performance assessment" and report exploratory data from an Internet search of performance assessment Information Technology (IT) solutions offered by IT providers. We use a classification of these IT solutions in order to identify and discuss new ways for assessing and for developing professionals in health care. We conclude by discussing differences and similarities between 360-degree feedback and peer review and by identifying current trends and possible future developments about how IT enables new assessment systems in this industry.

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A systematic review of medical practice variation in OECD countries

Cited by 251 publications

References 64 publications

The Relationship Between the Scope of Essential Health Benefits and Statutory Financing: An International Comparison Across Eight European Countries

The Relationship Between the Scope of Essential Health Benefits and Statutory Financing: An International Comparison Across Eight European Countries

Rates of admission for ambulatory care sensitive conditions in France in 2009–2010: trends, geographic variation, costs, and an international comparison

Using IT for Non-Hierarchical Performance Assessment: New Ways to Develop Professionals in Health Care

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