Health care variation: time to act.

Geographic variation in health care use has been demonstrated in many countries over many years. Such variation can be warranted - in response to patient need or preference for care - or unwarranted. Unwarranted variation raises concerns about equity and appropriateness of care. Recent analyses of health care provision in the Australian atlas of healthcare variation show that when routinely available Australian data are mapped by residence of patient, there are wide variations in rates of use of diagnostic tests, dispensing of prescriptions for a range of indications, surgical procedures and hospital admission rates. Despite the wealth of studies demonstrating variation in care internationally, there is relatively little research that explores the best ways of responding to unwarranted variation. Recommendations for action in the Australian Atlas focus on some approaches that could be used in Australia.

Australian hospital morbidity data on antibiotic resistance.

Reports of infections with drug-resistant microorganisms are included in the National Hospital Morbidity Database (NHMD) at the Australian Institute of Health and Welfare. This database includes data on diagnoses of patients admitted to Australian hospitals, recorded using codes from the Australian version of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification. Reports of infections with drug-resistant microorganisms, recorded as either the patient's principal diagnosis, or as a co-morbidity or complication, increased markedly between 1994-95 (when the first reports were included) and 2000-01. Infections resistant to penicillins were the most commonly recorded. The national introduction of the Australian versions of ICD-9-CM in 1995, and of casemix-based funding and management from the mid-1990s, has possibly led to more accurate medical record documentation and improved coding of these infections and are likely explanations for the observed increase in reporting. The NHMD should be considered as a component of a national surveillance system for antibiotic resistance. Its routine data collection covers almost all hospital separations in Australia and is supported by a comprehensive national data collection infrastructure.

Trends in hospital service provision.

In this paper, trends in hospital service provision are measured using data on the numbers and nature of hospitals, on hospital expenditure and on hospital activity over recent years. The number of public acute care hospitals was fairly stable, however, bed numbers decreased. Hospital numbers rose for private hospitals, as did numbers of beds, particularly for group for-profit private hospitals. Recurrent health expenditure on hospitals as a proportion of all recurrent health expenditure fell, although it rose for private hospitals, and real increases in expenditure occurred for both public acute and private hospitals. Population rates for separations and patient days rose for private hospitals and were stable and fell, respectively, for public acute hospitals. Average length of stay decreased for both public acute and private hospitals, with increasing numbers of separations occurring on a same day basis. Increasing proportions of procedures were undertaken during same day stays, and in private hospitals. Separation rates varied geographically, with highest rates overall, and for public hospitals and overnight separations, for patients resident in remote centres and other remote areas. Highest rates for private hospitals were for patients resident in capital cities, other metropolitan centres and large rural centres.