Geographic variation in the utilisation of health care interventions: what is the role of recommendations and other influences?

Geographic variation in the utilisation of healthcare services for chronic diseases
may indicate over- or underuse. Positive and negative clinical recommendations (e.g. within clinical guidelines, HTA reports or Choosing Wisely lists) and other factors may influence the degree of variation.

We will use health insurance claims data to describe geographic variation in the
use of healthcare interventions for chronic diseases in Switzerland. Associations with recommendation status and other factors will be assessed, e.g. using multilevel (linear mixed) regression modelling. Summary indicators of appropriateness of utilisation per geographic unit will be developed. Relationships with healthcare expenditure will be assessed; the applicability and usefulness of novel methods of analysis (trajectory analysis; 'counterfactual distributions') will be studied in this context. The status, quality and management of recommendations in Switzerland will be thoroughly assessed for eligible interventions (e.g. using the AGREE instrument).

Project results will have multifold implications for Swiss health policy makers and players in the healthcare system. To support dissemination, findings will be made publicly available on the internet. This and additional routes of dissemination will be pursued in cooperation with, at a minimum, physisican organisations, health insurance representatives and the Swiss cantons. The development of internet content will also involve patient organisations.

The project is funded by the SNF as part of NRP 74 'Smarter Healthcare'. It is performed in cooperation with a large provider of health insurance (Helsana), the Swiss Academy for Quality in Medicine / FMH, and other partners.