New health atlas for day surgery - still significant variation

The fundamental question addressed in the health atlases is whether health services are equitably distributed, regardless of residence. The first Norwegian health atlas was published on 13 January 2015 and provided an overview of twelve of the most common procedures typically performed as day surgery in Norway. The health atlas "Day Surgery 2011-2013" showed significant variation for most procedures.

 

The new health atlas describes the development in the scope and variation between the health trusts' catchment areas for the same twelve procedures during the period 2013–2017. The main data source is the Norwegian Patient Register, which contains information about publicly funded activity at public and private hospitals and with contracted specialists.

The geographical differences revealed by the Day Surgery Atlas from 2015 attracted attention both in professional circles, in the media, and from Health Minister Bent Høie. Despite this, the variation in the use of day surgical procedures remains significant between the health trusts' catchment areas.

For certain procedures, particularly shoulder surgery, ventilation tubes in the eardrum, and heavy eyelids, the variation between catchment areas increased.

 

Generally, the volume of day surgical procedures was relatively stable during the period 2013–2017. For the two procedures that were most discussed, shoulder surgery and meniscus procedures, there has been a significant decline in the number of procedures in recent years. For these procedures, there was already a professional debate regarding their utility, and the decline had begun before the Day Surgery Atlas from 2015 was launched.

 

The new day surgery atlas shows a significant increase from 2013 to 2017 in the volume of procedures for haemorrhoids and heavy eyelids.

 

The Day Surgery Atlas contributed to placing variation in the use of health services on the agenda and was followed up in both parliamentary reports and in the mandate documents from the Ministry of Health and Care Services to the

 

regional health trusts. SKDE finds that there has been little in the way of managerial measures taken to reduce variation based on the Day Surgery Atlas. In Health South-East, efforts to reduce shoulder and meniscus surgery had begun before the publication. In Health West, professional environments were invited to choose from a range of patient groups, procedures, and indicators that showed variation with the aim of establishing measures to reduce that variation, but none of the projects initiated in the health trusts were aimed at day surgical procedures. Following the publication of the Day Surgery Atlas, Health Mid-Norway has monitored the development in the use of day surgical procedures and used the information in dialogue with its health trusts, private hospitals, and contracted specialists.

 

There are some examples of professional environments in various health trusts changing practices after the variation became known. It seems that practice changes have primarily emerged as a result of professional discussions at the national or local level.

It has now been three years since the first Day Surgery Atlas was published and variation in the use of health services came onto the national health policy agenda. Changes take time. The results from the atlases are now being used more than before, including in the planning work of the regional health trusts.

 

The Medical Association's campaign "Make Wise Choices!" represents an important programme for discussing the utility of various investigations and treatments. This could also become a constructive approach to more systematic work aimed at reducing unjustified variation in health services.