title: A Window on Geographic Variation in Health Care: Insights from EuroHOPE.
abstract: The aim of EuroHOPE was to provide new evidence on the performance of healthcare systems, using a disease-based approach, linkable patient-level data and internationally standardized methods. This paper summarizes its main results. In the seven EuroHOPE countries, the Acute Myocardial Infarction (AMI), stroke and hip fracture patient populations were similar with regard to age, sex and comorbidity. However, non-negligible geographic variation in mortality and resource use was found to exist. Survival rates varied to similar extents between countries and regions for AMI, stroke, hip fracture and very low birth weight. Geographic variation in length of stay differed according to type of disease. Regression analyses showed that only a small part of geographic variation could be explained by demand and supply side factors. Furthermore, the impact of these factors varied between countries. The findings show that there is room for improvement in performance at all levels of analysis and call for more in-depth disease-based research. In using international patient-level data and a standardized methodology, the EuroHOPE approach provides a promising stepping-stone for future investigations in this field. Still, more detailed patient and provider information, including outside of hospital care, and better data sharing arrangements are needed to reach a more comprehensive understanding of geographic variations in health care.
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: Heijink
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Engelfriet
authors.affiliation: Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Clas
authors.initials: C
authors.lastname: Rehnberg
authors.affiliation: Frisch Centre, Oslo, Norway.
authors.forename: Sverre A C
authors.initials: SA
authors.lastname: Kittelsen
authors.affiliation: Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
mesh_terms: D019985:Benchmarking / Q000706:statistics & numerical data; D003695:Delivery of Health Care; D005060:Europe; D062306:Geography, Medical; D006295:Health Resources; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D020521:Stroke / Q000401:mortality* / Q000628:therapy
keywords: acute care practice; geographic variation; health outcomes; healthcare system; performance measurement