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The Impact of New Surgical Techniques on Geographical Unwarranted Variation: The Case of Benign Hysterectomy

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  • Daniel Adrian Lungu

    (Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy)

  • Elisa Foresi

    (Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy)

  • Paolo Belardi

    (Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy)

  • Sabina Nuti

    (Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant’Anna, 56127 Pisa, Italy)

  • Andrea Giannini

    (Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy)

  • Tommaso Simoncini

    (Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy)

Abstract

Since the 1980s, the international literature has reported variations for healthcare services, especially for elective ones. Variations are positive if they reflect patient preferences, while if they do not, they are unwarranted, and thus avoidable. Benign hysterectomy is among the most frequent elective surgical procedures in developed countries, and, in recent years, it has been increasingly delivered through minimally invasive surgical techniques, namely laparoscopic or robotic. The question therefore arises over what the impact of these new surgical techniques on avoidable variation is. In this study we analyze the extent of unwarranted geographical variation of treatment rates and of the adoption of minimally invasive procedures for benign hysterectomy in an Italian regional healthcare system. We assess the impact of the surgical approach on the provision of benign hysterectomy, in terms of efficiency (by measuring the average length of stay) and efficacy (by measuring the post-operative complications). Geographical variation was observed among regional health districts for treatment rates and waiting times. At a provider level, we found differences for the minimally invasive approach. We found a positive and significant association between rates and the percentage of minimally invasive procedures. Providers that frequently adopt minimally invasive procedures have shorter average length of stay, and when they also perform open hysterectomies, fewer complications.

Suggested Citation

  • Daniel Adrian Lungu & Elisa Foresi & Paolo Belardi & Sabina Nuti & Andrea Giannini & Tommaso Simoncini, 2021. "The Impact of New Surgical Techniques on Geographical Unwarranted Variation: The Case of Benign Hysterectomy," IJERPH, MDPI, vol. 18(13), pages 1-14, June.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:13:p:6722-:d:579702
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    References listed on IDEAS

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    1. Nuti, Sabina & Seghieri, Chiara, 2014. "Is variation management included in regional healthcare governance systems? Some proposals from Italy," Health Policy, Elsevier, vol. 114(1), pages 71-78.
    2. Nuti, Sabina & Vainieri, Milena & Bonini, Anna, 2010. "Disinvestment for re-allocation: A process to identify priorities in healthcare," Health Policy, Elsevier, vol. 95(2-3), pages 137-143, May.
    3. Siciliani, Luigi & Hurst, Jeremy, 2005. "Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries," Health Policy, Elsevier, vol. 72(2), pages 201-215, May.
    4. Nuti, Sabina & Vola, Federico & Bonini, Anna & Vainieri, Milena, 2016. "Making governance work in the health care sector: evidence from a ‘natural experiment’ in Italy," Health Economics, Policy and Law, Cambridge University Press, vol. 11(1), pages 17-38, January.
    5. Klim McPherson & Giorgia Gon & Maggie Scott, 2013. "International Variations in a Selected Number of Surgical Procedures," OECD Health Working Papers 61, OECD Publishing.
    6. Andrea Riganti & Luigi Siciliani & Carlo V. Fiorio, 2017. "The effect of waiting times on demand and supply for elective surgery: Evidence from Italy," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 92-105, September.
    7. Roos, N.P., 1984. "Hysterectomy: Variations in rates across small areas and across physicians' practices," American Journal of Public Health, American Public Health Association, vol. 74(4), pages 327-335.
    8. Sabina Nuti & Chiara Seghieri & Milena Vainieri, 2013. "Assessing the effectiveness of a performance evaluation system in the public health care sector: some novel evidence from the Tuscany region experience," Journal of Management & Governance, Springer;Accademia Italiana di Economia Aziendale (AIDEA), vol. 17(1), pages 59-69, February.
    9. Martina Ventura & Danilo Fusco & Katia Bontempi & Paola Colais & Marina Davoli, 2018. "Regional Outcome Evaluation Program (P.Re.Val.E.): Reduction of inequality in access to effective health care in the Lazio region of Italy (2012–2015)," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-14, March.
    10. repec:wly:hlthec:v:26:y:2017:i::p:92-105 is not listed on IDEAS
    11. Bevan, Gwyn & Evans, Alice & Nuti, Sabina, 2019. "Reputations count: why benchmarking performance is improving health care across the world," Health Economics, Policy and Law, Cambridge University Press, vol. 14(2), pages 141-161, April.
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