Regional variations in the use of common surgical procedures: Within and between England and Wales, Canada and the United States of America

The regional variations in age/sex standardized rates of common surgical operations in three countries are examined. Large differences between these countries are noted and possible explanations are examined. In England and Wales the extent to which particular surgical rates are related to indices of medical supply by Regional Health Authority are examined in detail. Overall hospital sector funding, relative to norms of medical “need”, are seen to be strongly positively related to many operation rates indicating a dependence on supply factors. The role of manpower levels in explaining utilization rates is examined in some detail to compare with empirical observations made in North America. Generally in a National Health Service context numbers of surgeons or general practitioners are not as strongly related as in the United States.

Finally these observations are examined in the context of previous work particularly on the role and nature of supply or induced demand.