The Relationship Between Geographic Variations and Overuse of Healthcare Services

OBJECTIVE: To examine the relationship between overuse of healthcare services and geographic variations in medical care. DESIGN: Systematic Review. DATA SOURCES: Articles published in Medline between 1978, the year of publication of the first framework to measure quality, and January 1, 2009. STUDY SELECTION: Four investigators screened 114,830 titles and 2 investigators screened all selected abstracts and articles for possible inclusion and extracted all data. DATA EXTRACTION: We extracted data on rates of overuse in different geographic areas. We also extracted data on underuse, if available, for the same population in which overuse was measured. RESULTS: Five papers examined the relationship between geographic variations and overuse of healthcare services. One study in 2008 compared the appropriateness of coronary angiography (CA) for acute myocardial infarction in high-cost areas versus low cost areas in the Medicare population and found largely similar rates of inappropriateness (12.2% vs. 16.2%). A study in 2000 using national data concluded that overuse of CA explained little of the geographic variations in the use of this procedure in the Medicare program. An older study of Medicare patients found similar rates of inappropriate use of CA (15% to 17% vs. 18%), endoscopy (15% vs. 18% 19%), and carotid endarterectomy (29% vs. 30%) in low-use and high-use regions. A small area reanalysis of data from this study of 3 procedures found no evidence of a relationship between inappropriate use of procedures and volume in 23 adjacent counties of California. Another 2008 study found that inappropriate chemotherapy for stage I cancer was less common in low-cost areas compared with high-cost areas (3.1% vs. 6.3%). CONCLUSIONS: The limited available evidence does not lend support to the hypothesis that inappropriate use of procedures is a major source of geographic variations in intensity and/or costs of care. More research is needed to improve our understanding of the relationship between geographic variations and the quality of care

Carotid arteries · Carotid endarterectomy · Environmental health · Family medicine · Health care · MEDLINE · Population · Economic and Financial Impacts of Cancer · Emergency Medicine · Health Systems, Economic Evaluations, Quality of Life · Healthcare cost, quality, practices · Internal Medicine · Medicine

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  Open Access•Tengteng Kang, Fangli Liu et al.•American Journal of Health Behavior•2023

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• Geographic variation in rates of common surgical procedures in France in 2008–2010, and comparison to the US and Britain

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• Elderly Breast and Colorectal Cancer Patients’ Clinical Course

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• Investigação em serviços de saúde

  Open Access•Mayã Martins, Margareth Crisóstomo Portela et al.•Cadernos de Saude Publica•2020

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• Small Area Variations in Health Care Delivery

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• The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions

  Open Access•A Liberati, D G Altman et al.•BMJ•2009

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• The Implications of Regional Variations in Medicare Spending. Part 2

  Open Access•Elliott S Fisher, David E Wennberg et al.•Annals of Internal Medicine•2003

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• The Implications of Regional Variations in Medicare Spending. Part 1

  Open Access•Elliott S Fisher, David E Wennberg et al.•Annals of Internal Medicine•2003

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• Impact of Underuse, Overuse, and Discretionary Use on Geographic Variation in the Use of Coronary Angiography After Acute Myocardial Infarction

  Edward Guadagnoli, Mary Beth Landrum et al.•Medical Care•2001

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