International Variations in a Selected Number of Surgical Procedures

This paper summarises recent international data on rates of five surgical procedures (i.e. caesarean, hysterectomy, prostatectomy, hip replacement and appendectomy) across OECD countries. It examines trends over time and compares age- and sex-specific rates for a recent year, for a sub-set of countries for which data are available. The report shows substantial international variations for most procedures, but also striking similarities between countries; some procedures show universal trends, with trends in rates by sex and age behaving in very similar ways. A full understanding of the reasons for and consequences of different utilisation rates demands a detailed understanding of patterns of illness and patient preferences, incentives embedded within health systems, and above all mechanisms to link activity to outcomes. While recognising the many limitations of the data that exist, the analyses reported here paint a picture of widespread differences in the rates at which certain procedures are performed (e.g. hysterectomy and prostatectomy) yet, for others (e.g. appendectomy), they indicate the emergence of growing international convergence. It is important to recognise that these findings are simply a stimulus to further enquiry into health services. Where variation is observed, there is no way, using these data alone, of knowing which rate is the “right” one in any country. It is not even possible to say that the presence of variation is a sign of important health service delivery problems.