International Journal of Health Economics and Policy

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Clinical Variation in Common Surgical Procedures in Australia: Implications for Health Expenditure

Received: Jan. 25, 2017    Accepted: Feb. 10, 2017    Published: Feb. 27, 2017
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Abstract

Introduction: Payments for surgical procedures through the Australian Medical Benefits Scheme (MBS) have a large effect on health budgets. We sought to evaluate the magnitude of surgical variation in five common surgical procedures: endometrial ablation; tonsillectomy in children; laparoscopic herniorraphy; cholecystectomy; and, knee arthroscopy. Methods: The MBS funds only a proportion of treatment costs affecting the potential affordability of surgery according to socio-economic factors. We hypothesised that lower rates of unemployment, higher average weekly earnings, a higher proportion of the population with private health insurance, and a higher percentage of the population in higher socio-economic brackets would be associated with a higher uptake of the procedures. Since surgery is more likely to be accessible in capital cities or larger regional centres, we also hypothesised that geographical isolation would be associated with lower access to surgical procedures. The relationship between surgical uptake and socio-economic factors was examined using linear regression and double bootstrap was used for statistical inference in an assumption-lean regression setting. Conclusion: We identified clinical variation in four of the five procedures studied. This variation was not associated with affordability or geographical access factors.

DOI 10.11648/j.hep.20170202.15
Published in International Journal of Health Economics and Policy ( Volume 2, Issue 2, June 2017 )
Page(s) 72-81
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Clinical Variation, Expenditure, Population, Budget, Regression

References
[1] Australian Institute of Health and Welfare. 2016. 25 years of health expenditure in Australia 1989-90 to 2013-14. Health and welfare expenditure series no. 56. Cat. No. HWE 63. Canberra: AIHW. Available at: http://www.aihw.gov.au/publication-detail/?id=60129554398.
[2] Duckett SJ, Breadon P, Weidmann B, Nicola I. Controlling costly care: a billion dollar hospital opportunity. 2014 Grattan Institute, Melbourne.
[3] Boxall, Anne-Marie. What are we doing to ensure the sustainability of the health system? Research paper no. 4, 2011-2012. Parliamentary Library. Accessible at: http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1112/12rp04.
[4] Marmor T, Freeman R, Okma K. Comparative perspectives and policy learning in the world of health care. Journal of Comparative Policy Analysis 2005; 7 (4): 331 – 348.
[5] Hall RE, Jones CI. The Value of Life and the Rise in Health Spending. Quarterly Journal of Economics 2007: 122 (1): 39 - 72. doi: 10.1162/qjec.122.1.39.
[6] Medical Benefits Reviews Task Group. 2010. Development of a quality framework for the Medicare Benefits Schedule. Discussion paper. Canberra: Australian Government Department of Health and Aging. 2010. Accessible at: https://www.chf.org.au/pdfs/chf/DoHA_Information_Paper_Development_of_a_Quality_Framework_for_the_MBS_Discussion_Paper.pdf )
[7] Kennedy PJ, Leathly CM, Hughes CF. ‘Clinical practice variation’. Medical Journal of Australia 2010; 193: 597–599.
[8] Buchan H, Sewell JR, Sweet M. Translating evidence into practice. Medical Journal of Australia 2004; 180: S43.
[9] Davis DA, Taylor-Vaisey A. Translating guidelines into practice: a systematic review of theoretical concepts, practical experience and research evidence in the adoption of clinical practice guidance. Canadian Medical Association Journal 1997; 157: 408–416.
[10] Australian Commission on Quality and Safety in Healthcare. 2016: Australian atlas of healthcare variation. Accessible at: http://www.safetyandquality.gov.au/atlas/.
[11] Australian Institute of Health and Welfare. Elective surgery waiting times 2014–15: Australian hospital statistics. Health services series no. 64. Cat. no. HSE 166. 2016, Canberra: AIHW.
[12] ABS 6202.0 - Labour Force, Australia. Available at: http://www.abs.gov.au/ausstats/abs%40.nsf/mf/6202.0.
[13] ABS 6302.0 - Average Weekly Earnings, Australia. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/6302.0.
[14] ABS 3101.0 - Australian Demographic Statistics. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/3101.0.
[15] ABS 3218.0 - Regional Population Growth. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/3218.0.
[16] Australian Prudential Regulation Authority (APRA). 2015. ‘Privately Insured People with Hospital Treatment Cover Annual Analysis Sex, Age and State’. Available at: http://www.apra.gov.au/PHI/Publications/Documents/1605%20Annual%20PHI%20survey-report%2020151231.pdf.
[17] McCarthy D, Zhang K, Brown L, Berk R, Buja A, Geoge E, Zhao L. Calibrated percentile double Bootstrap for robust linear regression inference. 2016 arXiv:1511.00273, last revised 16 Jun 2016. Accessiable Available at: http://128.84.21.199/abs/1511.00273.
[18] McCarthy D. 2016. ‘perccal: Implementing Double Bootstrap Linear Regression Confidence’.
[19] Hollingworth W, Rooshenas L, Busby J, Hine CE, Badrinath P, et al. Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study. Health Serv Delivery Res. 2015; 3 (13): ISSN 2050-4349. DOI 10.3310/hsdr03130.
[20] Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q; 2004; 82: 581–629.
[21] Elshaug AG, Hiller JE, Moss JR. Exploring policy-makers’ perspectives on disinvestment from ineffective healthcare practices. Int J Technol Assess Health Care 2008; 24: 1–9.
[22] Drummond M, Cooke J, Walley T. Economic evaluation under managed competition: evidence from the U. K. Soc Sci Med 1997; 45: 583–95.
[23] Eddama O, Coast J. A systematic review of the use of economic evaluation in local decision-making. Health Policy 2008; 86: 129–41.
[24] Australian Medical Association (AMA). Public Hospital Report Card 2015. Accessible at: https://ama.com.au/article/ama-public-hospital-report-card-2015.
[25] Elshaug AG, Hiller JE, Tunis SR, Moss JR. Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Aust N Z Health Policy 2007; 4: 23.
[26] Elshaug AG, Watt AM, Mundy L, Willis CD. Over 150 potentially low-value health care practices: an Australian study. Med J Aust 2012; 197: 556–60.
[27] Woolf SH, Grol R, Hutchinson A, et al. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. Br Med J 1999; 318: 527-530.
[28] Farquhar CM, Kofa EW, Slutsky JR. Clinicians’ attitudes to clinical practice guidelines: a systematic review. Med J Aust 2002; 177: 502–506.
[29] Vollman K, Sprung P, Posa S. Strategies for reducing material costs through implementation of clinical guidelines. J Soc Health Syst 1998; 5: 69-73.
[30] Pitimana-Aree S, Forrest D, Brown G. Implementation of a clinical practice guideline for stress ulcer prophylaxis increases appropriateness and decreases cost of care. Intensive Care Med 1998; 24: 217-223.
[31] Glover JA. The incidence of tonsillectomy in school children. Int J Epidemiol 1930; 37: 9–19.
[32] Burton MJ, Glasziou PP, Chong L, Venekamp RP. 2014. ‘Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis’. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD001802. DOI: 10.1002/14651858. CD001802. pub3.
[33] McCormack K, Scott N, Go PM. N. Y. H, Ross SJ, Grant A. ‘Collaboration the EU Hernia Trialists. Laparoscopic techniques versus open techniques for inguinal hernia repair’. Cochrane Database of Systematic Reviews 2003 Issue 1. Art. No.: CD001785. DOI: 10.1002/14651858. CD001785.
[34] Keus F, Gooszen HG, van Laarhoven CJHM. Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews. Cochrane Database of Systematic Reviews, 2010 Issue 1. Art. No.: CD008318. DOI: 10.1002/14651858. CD008318.
[35] Fergusson RJ, Lethaby A, Shepperd S, Farquhar C. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database of Systematic Reviews. 2013. DOI: 10.1002/14651858. CD000329. pub2.
[36] Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. British Medical Journal 2015; 350; h2747. doi: http://dx.doi.org/10.1136/bmj.h2747.
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  • APA Style

    Louise Rawlings, Pauline Ding, Stephen J. Robson. (2017). Clinical Variation in Common Surgical Procedures in Australia: Implications for Health Expenditure. International Journal of Health Economics and Policy, 2(2), 72-81. https://doi.org/10.11648/j.hep.20170202.15

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    ACS Style

    Louise Rawlings; Pauline Ding; Stephen J. Robson. Clinical Variation in Common Surgical Procedures in Australia: Implications for Health Expenditure. Int. J. Health Econ. Policy 2017, 2(2), 72-81. doi: 10.11648/j.hep.20170202.15

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    AMA Style

    Louise Rawlings, Pauline Ding, Stephen J. Robson. Clinical Variation in Common Surgical Procedures in Australia: Implications for Health Expenditure. Int J Health Econ Policy. 2017;2(2):72-81. doi: 10.11648/j.hep.20170202.15

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  • @article{10.11648/j.hep.20170202.15,
      author = {Louise Rawlings and Pauline Ding and Stephen J. Robson},
      title = {Clinical Variation in Common Surgical Procedures in Australia: Implications for Health Expenditure},
      journal = {International Journal of Health Economics and Policy},
      volume = {2},
      number = {2},
      pages = {72-81},
      doi = {10.11648/j.hep.20170202.15},
      url = {https://doi.org/10.11648/j.hep.20170202.15},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.hep.20170202.15},
      abstract = {Introduction: Payments for surgical procedures through the Australian Medical Benefits Scheme (MBS) have a large effect on health budgets. We sought to evaluate the magnitude of surgical variation in five common surgical procedures: endometrial ablation; tonsillectomy in children; laparoscopic herniorraphy; cholecystectomy; and, knee arthroscopy. Methods: The MBS funds only a proportion of treatment costs affecting the potential affordability of surgery according to socio-economic factors. We hypothesised that lower rates of unemployment, higher average weekly earnings, a higher proportion of the population with private health insurance, and a higher percentage of the population in higher socio-economic brackets would be associated with a higher uptake of the procedures. Since surgery is more likely to be accessible in capital cities or larger regional centres, we also hypothesised that geographical isolation would be associated with lower access to surgical procedures. The relationship between surgical uptake and socio-economic factors was examined using linear regression and double bootstrap was used for statistical inference in an assumption-lean regression setting. Conclusion: We identified clinical variation in four of the five procedures studied. This variation was not associated with affordability or geographical access factors.},
     year = {2017}
    }
    

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  • TY  - JOUR
    T1  - Clinical Variation in Common Surgical Procedures in Australia: Implications for Health Expenditure
    AU  - Louise Rawlings
    AU  - Pauline Ding
    AU  - Stephen J. Robson
    Y1  - 2017/02/27
    PY  - 2017
    N1  - https://doi.org/10.11648/j.hep.20170202.15
    DO  - 10.11648/j.hep.20170202.15
    T2  - International Journal of Health Economics and Policy
    JF  - International Journal of Health Economics and Policy
    JO  - International Journal of Health Economics and Policy
    SP  - 72
    EP  - 81
    PB  - Science Publishing Group
    SN  - 2578-9309
    UR  - https://doi.org/10.11648/j.hep.20170202.15
    AB  - Introduction: Payments for surgical procedures through the Australian Medical Benefits Scheme (MBS) have a large effect on health budgets. We sought to evaluate the magnitude of surgical variation in five common surgical procedures: endometrial ablation; tonsillectomy in children; laparoscopic herniorraphy; cholecystectomy; and, knee arthroscopy. Methods: The MBS funds only a proportion of treatment costs affecting the potential affordability of surgery according to socio-economic factors. We hypothesised that lower rates of unemployment, higher average weekly earnings, a higher proportion of the population with private health insurance, and a higher percentage of the population in higher socio-economic brackets would be associated with a higher uptake of the procedures. Since surgery is more likely to be accessible in capital cities or larger regional centres, we also hypothesised that geographical isolation would be associated with lower access to surgical procedures. The relationship between surgical uptake and socio-economic factors was examined using linear regression and double bootstrap was used for statistical inference in an assumption-lean regression setting. Conclusion: We identified clinical variation in four of the five procedures studied. This variation was not associated with affordability or geographical access factors.
    VL  - 2
    IS  - 2
    ER  - 

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Author Information
  • Regulatory Institutions Network, Australian National University, Canberra, Australia

  • Statistical Consulting Unit, Australian National University, Canberra, Australia

  • Australian National University Medical School, Canberra, Australia

  • Section