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

Abstract

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.