Strong deviations in operations

Significant regional differences in the number of operations

09/13/2014

There are considerable regional deviations in the operations performed in German hospitals „can be explained as medically purely just as little as through age or gender structures“, reports the Bertelsmann Stiftung, citing the results of two recent studies carried out together with the OECD. The study results prove that there are major regional differences in health care, according to the Bertelsmann Stiftung.

„Even in very high-performing healthcare systems, adequate medical care often depends on where you live“, explain the study authors. Here the current study results are a clear warning sign. For from a medical point of view, the discrepancies found in the operations performed can not be explained, according to the Bertelsmann Stiftung statement. In some regions of Germany will „operated on eight times more often than elsewhere.“ This is documented in the two current studies of the OECD and the Bertelsmann Stiftung for Germany and twelve other industrial nations.

Quality, efficiency and equity issues
According to the Bertelsmann Foundation, the studies conclude that „In some cities and counties, eight times more people will be almonds than elsewhere“ and „similarly large regional differences in the removal of the cecum, the prostate or in the insertion of a defibrillator on the heart“ be determined. These deviations are cause for concern for the experts, because „large regional differences in health care are a clear sign of quality, efficiency and equity issues“, stressed the OECD director Mark Pearson. The study authors will present their results in more detail at a joint conference of the OECD and Bertelsmann Foundation next Tuesday.

Medical needs no explanation
According to the Bertelsmann Stiftung, the current study results are based on a long-term study that has been ongoing since 2007. Since then, the Bertelsmann Stiftung has been responsible for the fact check on health „the frequency of operations in all 402 German districts and independent cities“ recorded and thereby according to own data „Stupendous noticed.“ Thus, the extent of regional differences within Germany over the years in the individual medical interventions remained almost constant. That's it „also predominantly the same regions that constantly suffer from a particular over- or under-supply.“ For example, in some county-level cities and districts such as Bad Kreuznach, Bremerhaven or Delmenhorst, eight times as many children have taken almonds out as they have elsewhere. Dr. Brigitte Mohn from the board of the Bertelsmann Stiftung stated that here „obviously other factors play a role than just medical necessity.“

Significant deviations in almond operations
Significant regional deviations in the frequency of operations are, for example „also with the use of artificial knee joints, with caesarean sections or uterine removal“ determine, reports the Bertelsmann Foundation. Here, the frequency of operations between the regions differs in part by two to three times. For other European countries such as France, Spain and England, the OECD comes to a similar conclusion. The massive deviations are by no means explained by isolated outliers in the statistics, but quite a few regions deviate significantly from the average values. „In terms of almond distances, for example, 137 of the 402 German cities and municipalities deviate by more than 30 percent from the national average“, This is the message from the Bertelsmann Foundation. The authors of the study conclude that affected children are either over- or underserved in every third city and every third district.

Malformations at the expense of the patient
Individual regions are, according to the latest study results, veritable operations centers. So be noticeable, „that some independent cities and districts have the highest operating rates in Germany with several interventions“, reports the Bertelsmann Foundation. Here recommend the OECD and the Bertelsmann Foundation „It is urgent for the medical associations and specialist societies, but also the competent supervisory authorities, to examine these conspicuous regions thoroughly.“ Dr. Brigitte Mohn added that it is difficult to understand why no one is researching the causes of the long-standing large regional differences in operations. Here could be „hide behind the numbers in some regions true aberrations at the expense of patients“, warned poppy.

Missing explanations for the deviations in the frequency of operations
Although explanations of the massive regional deviations in the frequency of operations would certainly be desirable, however, the studies of the OECD and the Bertelsmann Foundation provide little information in this regard. One possible explanatory approach, for example, is the lack of a clear medical guideline, which increases the risk of regional differences. „Guidelines defining the range of action of physicians should exist for all surgical procedures“, stressed Brigitte Poppy. But must „their compliance are strictly controlled - with all necessary medical freedom of choice in individual cases.“ In addition, extreme values, as found in various cities and counties, are an indication that medical education is perceived regionally differently. Although patients usually expect doctors to be understandably and neutrally informed about alternative treatments, this often does not seem to happen. Therefore, patients should also demand this, explained Mark Pearson. A certain skepticism about surgical recommendations is therefore quite appropriate. The decision for or against an operation should not be a matter of supply capacity or the habits of local physicians, the experts warn. (Fp)