Weeks William B, Paraponaris Alain, Ventelou Bruno
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, United States; The Aix-Marseille School of Economics, Marseille, France.
The Aix-Marseille School of Economics, Marseille, France; SESSTIM, UMR 912 INSERM-IRD-Aix-Marseille Université, Marseille, France; Observatoire Régional de la Santé PACA, Marseille, France.
Health Policy. 2014 Nov;118(2):215-21. doi: 10.1016/j.healthpol.2014.08.015. Epub 2014 Sep 8.
Geographic variation in use of elective surgeries has been widely studied in the US, where over-utilization is incentivized. We wanted to explore recent trends in the geographic variation of common surgical procedures in France--where a global budget, centralized planning process, and compulsory insurance scheme are in place--and to compare measures of variation there to those in the US and Britain. For 2008-2010, we calculated French age- and sex-adjusted per capita utilization rates and four measures of geographic variation for hip fracture admission (which is standard treatment and shows minimal geographic variation across countries) and 14 elective surgical procedures. We found substantial geographic variation in age-sex adjusted per capita admission rates for elective procedures: radical prostatectomy, spine surgery, and CABG showed the greatest variation, while hip fracture, colectomy, and cholecystectomy showed the least. Among older patients, most French admission rates were lower than those seen in the US. In general, measures of geographic variation were lower in France than those reported in the US or Britain. French policymakers could use analyses of geographic variation in service utilization to inform policy, to identify areas for intervention, or to measure the effectiveness of efforts designed to reduce variation in care.
在美国，选择性手术的使用情况的地域差异已得到广泛研究，在那里过度使用是受到激励的。我们想要探究法国常见外科手术地域差异的近期趋势——法国实行全球预算、集中规划流程和强制保险计划——并将法国的差异衡量指标与美国和英国的进行比较。对于2008年至2010年，我们计算了法国按年龄和性别调整的人均利用率以及髋部骨折入院（这是标准治疗且在各国间地域差异极小）和14种选择性外科手术的四种地域差异衡量指标。我们发现选择性手术的年龄-性别调整后的人均入院率存在显著的地域差异：根治性前列腺切除术、脊柱手术和冠状动脉搭桥术的差异最大，而髋部骨折、结肠切除术和胆囊切除术的差异最小。在老年患者中，大多数法国的入院率低于美国。总体而言，法国的地域差异衡量指标低于美国或英国报告的指标。法国政策制定者可以利用服务利用的地域差异分析来为政策提供信息，识别干预领域，或衡量旨在减少医疗差异的努力的有效性。
