Geographical variations in the use of diagnostic imaging of musculoskeletal diseases in Norway

Abstract

Background There is a high prevalence of musculoskeletal disorders in the Norwegian population. A significant number of these patients are referred to diagnostic imaging. Geographical variations in the use of imaging for musculoskeletal disorders may display over- or underuse, and knowledge about these variations is required. Purpose To investigate geographical variations in diagnostic imaging of the musculoskeletal system and analyze variations in the use of these examinations of all musculoskeletal diagnostic imaging, the specific modalities, and specific examinations. Material and Methods Population rates from Statistics Norway and outpatient radiological procedures of the musculoskeletal system registered at the Norwegian Health Economics Administration (HELFO) the first half of 2016 were accessed. The HELFO data were age-adjusted; high/low ratios were calculated as rates in number of examinations per 1000 inhabitants. A high/low ratio of 1 = equal use, 1.5–1.9 = moderate variation (approximately 50% difference), and > 2 (twice as much) = high variation. Results Geographical variations were demonstrated at all levels, with an overall high/low ratio of 1.3. For specific modalities the highest variation was for ultrasound (3.2) and CT (2.2). For individual examinations, the highest high/low ratios were observed for MRI of the shoulder (2.4) and radiography of the lower back (1.9) and shoulder (1.8). Conclusion We demonstrate a moderate to high geographical variation in the use of diagnostic imaging of the musculoskeletal system. This variation can indicate over- or underuse, which may violate basic principles of equity, priority, setting and appropriate care, and needs further attention.

Effects of a reimbursement change and travel times on the delivery of private and public radiology services in Norway: a register-based longitudinal study of Norwegian claims data

“…In general, the fact that in some areas many patients transferred from private to public providers is not necessarily efficient because it indicates that patients that are rationed by private providers are now treated by public providers, shifting the market from private to public providers and implying that not only patients with the lowest expected benefit were rationed from private providers. Thus, when comparing these results to Norwegian and international literature, it is difficult to fully support the statement that geographical variation in the reaction to reimbursement change seems to origin from overuse of services, although in general overuse and underuse of radiology services have shown to be a challenge in many countries including Norway [8–10, 23]. When it comes to the research of the reimbursement change in this study, the coexistence of private and public providers have a heavier role than the heterogenous use of services, as it was already pointed out in 2002 [24].…”

“…Regional variation persisted for age-and-gender-adjusted rates [22]. A study by Gransjøen et al (2018) analysed diagnostic imaging of the musculoskeletal system from 2016 and found geographical variation, especially for ultrasound and CT, MRI of the shoulder and radiography of lower back and shoulder, which might indicate overuse or underuse of services [23]. Lysdahl and Børrentzen, who analysed survey data from 2002, found substantial variation especially for CT and MRI.…”

Variation in use of open and laparoscopic distal pancreatectomy and associated outcome metrics in a universal health care system

“…Previous data from Norway have reported a considerable variation (60% variation) in use of imaging studies between the urban capitol of Oslo (in the SouthEast) and the more rural district in county Finnmark (in the North) [33]. The difference has recently been corroborated when investigated for musculoskeletal imaging studies [34] and in an audit from the Office of the Auditor General, finding a more than 3-fold difference in population-adjusted use of CT and MRI use across health trusts [35]. Thus, a higher than expected use of cross-sectional imaging in the SouthEast may translate into a higher number of incidental lesions, leading off to a higher number of resections per population.…”

Associations between utilization rates and patients’ health: a study of spine surgery and patient-reported outcomes (EQ-5D and ODI)

“…In any case, better knowledge about whether physicians should consider lifestyle factors when considering treatment options, might lead to more similar decision-making processes and reduction of unwarranted variation. Such ambiguity is also present in primary care, and reflected in the rate of patients who are reffered to diagnostic imaging [25].…”