- It is often difficult to pinpoint the sources of variation in outcomes and costs. For effective variation reduction strategies, more insight is required into at what level(s) (e.g., hospitals, professionals, patients) variation exists.
- Partitioned physician-level variation was typically low and is generally exceeded by hospital-level variation. Additionally, case-mix corrected comparisons on outcomes and costs between individual physicians were unreliable, whereas the opposite often appears to hold for hospitals.
- Variation-reduction strategies should be designed and applied with caution and with consideration of the potentially large differences in both level-specific attributed variation and reliability that may exist across treatments and outcomes.
Publication stageIn Press Accepted Manuscript
An anonymous database was built from existing reimbursement data that had been amassed by hospitals under the Dutch Healthcare Act (Nederlandse Gezondheidswet). Since this study was based on legally obtained, existing, anonymous data, no additional informed consent was required. All methods were carried out in full accordance with privacy regulations and guidelines.
Concept and design: Salet, Stangenberger, Eijkenaar
Acquisition of data: Salet, Stangenberger, Bremmer
Analysis and interpretation of data: Salet, Stangenberger, Bremmer, Eijkenaar
Drafting of the manuscript: Salet, Stangenberger
Critical revision of the paper for important intellectual content: Salet, Stangenberger, Bremmer, Eijkenaar
Statistical analysis: Salet, Stangenberger
Provision of study materials or patients: Salet, Bremmer
Obtaining funding: Eijkenaar
Administrative, technical, or logistic support: Bremmer
Conflict of interest statement
The authors reported no conflicts of interest.
The authors gratefully acknowledge the valuable feedback of Erik Schut and Freek Sorgdrager on an earlier draft, as well as the comments of participants of the Erasmus Health Systems and Insurance seminar (October 2021).
User LicenseCreative Commons Attribution (CC BY 4.0) |
- Read, print & download
- Redistribute or republish the final article
- Text & data mine
- Translate the article
- Reuse portions or extracts from the article in other works
- Sell or re-use for commercial purposes
Elsevier's open access license policy