title: Geographic variation in selected hospital procedures and services in the Israeli health care system.
abstract: Medical practice variation refers to differences in health service utilization among regions in the same country. It is used as a tool for studying health inequities. In 2011, the OECD launched a Medical Practice Variation Project which examines regional differences within countries and explores the sources of the inter-regional differences. The aim of this study is to examine the patterns and trends in geographic variation for selected health services in Israel.
  
  
  
  The analysis is based on data from the National Hospital Discharges Database (NHDD) of the Israeli Ministry of Health. The eight procedures and services studied were: medical admissions (i.e. admissions without surgical procedures); hip fractures; caesarian sections; diagnostic cardiac catheterization; cardiac angioplasty (PTCA); cardiac bypass surgery (CABG); hysterectomy; and knee replacement surgery. The data are presented for the 7 districts in Israel, determined by address of residence.
  
  
  
  The procedures and services with the lowest variation across the seven districts were medical admissions (RR between regions-maximum/minimum 1.3) and hip fractures (RR 1.44), while the one with the highest variation was CABG (RR 1.98). The Israeli periphery, and the northern district in particular, had higher rates of medical admissions, knee replacement and cardiac procedures. When studying the trend over time, we found a decrease in use rates for most procedures, such as coronary bypass (R. 04) and CABG (R 0.8). Medical admissions decreased by 8%, with the highest decline (16%) observed in the central districts.
  
  
  
  This study provides Israeli policy makers with information which is vital for the strategic planning of service development, such as strengthening preventive medical services in the community, reducing cardiovascular risk factors in the periphery and expanding the national publication of clinical quality scores.
authors.affiliation: Ministry of Health, Israel, Jerusalem, 93722 Israel ; Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Joseph
authors.initials: J
authors.lastname: Mendlovic
authors.affiliation: Ministry of Health, Israel, Jerusalem, 93722 Israel.
authors.forename: Ethel-Sherry
authors.initials: ES
authors.lastname: Gordon
authors.affiliation: Ministry of Health, Israel, Jerusalem, 93722 Israel.
authors.forename: Ziona
authors.initials: Z
authors.lastname: Haklai
authors.affiliation: Ministry of Health, Israel, Jerusalem, 93722 Israel.
authors.forename: Jill
authors.initials: J
authors.lastname: Meron
authors.affiliation: Ministry of Health, Israel, Jerusalem, 93722 Israel ; Sackler school of medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Afek
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D005843:Geography / Q000639:trends*; D006620:Hip Fractures / Q000453:epidemiology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D007557:Israel / Q000453:epidemiology; D017064:Process Assessment, Health Care / Q000379:methods / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D017062:Small-Area Analysis
keywords: Geographic variations; Ministry of Health; PTCA; Periphery