title: Examining regional variation in health care spending in British Columbia, Canada.
abstract: Examining regional variation in health care spending may reveal opportunities for improved efficiency. Previous research has found that health care spending and service use vary substantially from place to place, and this is often not explained by differences in the health status of populations or by better outcomes in higher-spending regions, but rather by differences in intensity of service provision. Much of this research comes from the United States. Whether similar patterns are observed in other high-income countries is not clear. We use administrative data on health care use, covering the entire population of the Canadian province of British Columbia, to examine how and why health care spending varies among health regions. Pricing and insurance coverage are constant across the population, and we adjust for patient-level age, sex, and recorded diagnoses. Without adjusting for differences in population characteristics, per-capita spending is 50% higher in the highest-spending region than in the lowest. Adjusting for population characteristics as well as the very different environments for health service delivery that exist among metropolitan, non-metropolitan, and remote regions of the province, this falls to 20%. Despite modest variation in total spending, there are marked differences in mortality. In this context, it appears that policy reforms aimed at system-wide quality and efficiency improvement, rather than targeted at high-spending regions, will likely prove most promising.
authors.affiliation: Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, Canada V6T 1Z3. Electronic address: ruth_lavergne@sfu.ca.
authors.forename: Miriam Ruth
authors.initials: MR
authors.lastname: Lavergne
authors.affiliation: Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, Canada V6T 1Z3. Electronic address: morris.barer@ubc.ca.
authors.forename: Morris
authors.initials: M
authors.lastname: Barer
authors.affiliation: Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, Canada V6T 1Z3. Electronic address: michael.law@ubc.ca.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Law
authors.affiliation: Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, Canada V6T 1Z3. Electronic address: sabrina.wong@nursing.ubc.ca.
authors.forename: Sabrina T
authors.initials: ST
authors.lastname: Wong
authors.affiliation: Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, Canada V6T 1Z3. Electronic address: sandra.peterson@ubc.ca.
authors.forename: Sandra
authors.initials: S
authors.lastname: Peterson
authors.affiliation: Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, BC, Canada V6T 1Z3. Electronic address: kim.mcgrail@ubc.ca.
authors.forename: Kimberlyn
authors.initials: K
authors.lastname: McGrail
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000191:economics; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D005843:Geography; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D019472:Universal Health Insurance
keywords: Geographic variations in medical practice; Health care utilization; Health policy; Small area analysis