Geographic variation of hysterectomy rates in the Israeli health care system during the years 2007–2016

Abstract

Background In 2014 the OECD published a report regarding inter-regional variation of hysterectomies in 13 countries including Israel. Variance in hospital admission rates were also reported. The Israeli Ministry of Health has set as one of its main goals the reduction in differences in health care, particularly between the country’s periphery and central regions. These variations may reflect differences in characteristics, resource allocation, and medical staff employment, expertise and training. The advances in technology in the last decades including laparoscopic and robotic surgeries and the variance in their implementation emphasize the great regional variance. The aim of this study was to examine hysterectomy trends in the past decade with emphasis on regional differences. Methods The study is based on information maintained by the Israeli Ministry of Health and portrays the trend in hysterectomy rates as a factor of indication, surgical approach and length of hospitalization as collected from the years 2007–2016. Results Inter-regional significant differences were found between the 7 regions of Israel, though there was a clear trend toward a national 11–24% decrease in hysterectomy rates. A 2–4 time increase in laparoscopic hysterectomies was observed. There was a clear country-wide trend toward shortening hospital stay from 5 to 4 days in total. Conclusions Hysterectomy rates have declined in the past decade due to the implementation of new technologies allowing earlier diagnosis and minimally invasive surgery on top of offering alternative, non-surgical treatment modalities. Uneven allocation of resources and manpower allowing technology implementation and optimal medical services may have contributed to the findings.

Change in medical practice over time? A register based study of regional trends in hysterectomy in Finland in 2001–2018

“…While most studies investigating differences in use of hysterectomy have been longitudinal, studies on temporal variations within one country are rare. Additionally, many of the studies examining regional variation do so with total hysterectomy rates [ 5 , 7 , 11 , 12 ] and only a few separate between rates for benign and malign conditions [ 8 , 13 ].…”

Opportunities for diversifying and enriching our article mix

“…Israel's Ministry of Health, including sub-units such as the Gertner Institute for Epidemiology and Health Policy Research and the Israel Center for Disease Control, was the database owner for 10 of these articles. Maccabi Healthcare Services 5 and the Hadassah Medical Organization were each the database owners for 2 of the articles, and the Ministry of Defense, Sha'are Zedek Medical Center, and Terem 6 were each the database owners for one of the articles. In 16 of these articles, there was at least one author from within the organization that owns the relevant database.…”

“…In short, investigators from outside the owning organization are occasionally Interestingly, of the 11 integrative articles the IJHPR published in 2019, 2 explored the impact of national program or policy changes and 1 explored the impact of a health plan program change. 5 Maccabi is Israel's second largest health plan, with over 2 million members 6 Terem is a network of emergency medical centers involved in articles based on databases, but almost always in conjunction with investigators from within the owning organization and rarely as the lead authors.…”

“…The other article found that ethnic differences occur in violence-related injuries and recommended that violence prevention programs should be culturally adapted [ 4 ]. An article by investigators from the Ministry of Health (MOH) and elsewhere used an MOH database on hospitalizations and procedures to explore how hysterectomy rates vary across regions and how they changed between 2007 and 2016 [ 5 ]. It found a decline in rates which are apparently due in part to the implementation of new technologies allowing earlier diagnosis, minimally invasive surgery, and alternative, non-surgical treatment modalities.…”

Using Geographically Weighted Poisson Regression to Examine the Association Between Socioeconomic Factors and Hysterectomy Incidence in Wallonia, Belgium

“…Since the 1970s, numerous studies have shown variation in hysterectomy practices between countries or regions within countries (7,12,13). Those regional variations are potentially a sign of the nonoptimal use of resources or healthcare inequalities (8,14). It is, therefore, important to identify the causes of the unexplained overuse of hysterectomies in some regions.…”