Spain: Geographic variations in health care

This chapter outlines geographic variations in Spain at the provincial and regional levels in the period 2000-10. Hospital admission rates remained stable over time and across regions, with relatively little geographic variation. While caesarean section rates increased in Spain up to 2005, and then decreased, greater variation is observed at the province level. Caeserean section rates have continued to rise in private hospitals, while the trend has been reversed in public hospitals. The overall rates of hysterectomy and the variation across regions decreased during the study period. Cardiovascular procedures (CABG, PTCA and catheterisation) show great variations between provinces, although the variations have decreased over time for PTCA. The number of joint procedures increased over time, with great variation, particularly for knee arthroscopies and knee replacements. As expected, variations across regions have been lower and more stable for surgery after hip fracture. The recent experience in reducing caesarean section rates in many public hospitals provides a good example of the possibility of reducing the overuse of certain interventions through the development and implementation of clinical guidelines in a way that involves all key stakeholders. Nevertheless, the challenge remains to extend this approach to all regions and hospitals.