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

Louise Rawlings; Pauline Ding; Stephen J. Robson

doi:doi:10.11648/j.hep.20170202.15

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

Louise Rawlings, Pauline Ding, Stephen J. Robson

Published in International Journal of Health Economics and Policy (Volume 2, Issue 2)

Received: 25 January 2017 Accepted: 10 February 2017 Published: 27 February 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.

Published in	International Journal of Health Economics and Policy (Volume 2, Issue 2)
DOI	10.11648/j.hep.20170202.15
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), 2017. Published by Science Publishing Group

Keywords

Clinical Variation, Expenditure, Population, Budget, Regression

References

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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://article.sciencepublishinggroup.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

Louise Rawlings

Regulatory Institutions Network, Australian National University, Canberra, Australia
Pauline Ding

Statistical Consulting Unit, Australian National University, Canberra, Australia
Stephen J. Robson

Australian National University Medical School, Canberra, Australia

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Plain Text BibTeX RIS

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

Copy | Download

@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://article.sciencepublishinggroup.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}
}

Copy | Download

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  -

Copy | Download