Researchers: Ehud Davidson¹, Shlomi Kodesh¹, Lena Novack², Maayan Yitshak-Sade³

Background: In developed countries there is an upward trend in national expenditure on health services. The variation in the use of health care raises questions about quality, cost and efficiency, and has significant health implications.

Objectives: 1. To describe the variation in the use of health services among primary care physicians.
2. To identify the association between the patient and physician characteristics and the utilization of health services.
3. Assess the extent to which patient and physician characteristics explain the variance.

Method: A retrospective cohort study of the variation between primary care physicians in the Southern distcrit of the Clalit HMO between 2003 and 2013, in 16 health services in the fields of: imaging, laboratory, heart tests, referral to ERs and referrals to consultant medicine.
We calculated the variation by the COV and we conducted univariate and multivariate mixed-models analyses to infer the association between the patients and physicians characteristics and the utilization of health services, and to calculate the explained variance.

Findings and conclusion: Among primary care physicians there is a large variation. Factors associated with high rates of health services utilization are family medicine specialty, age of patients, socioeconomic status of patients, percentage of men and total insured.

Recommendations: We suggest conducting similar studies in other districts in Israel that will accurately include referral rates, as well as other factors not examined in our study, such as personality characteristics of physicians. This, in order to identify the major factor associated with the variation and accordingly to plan interventional programs to reduce it.

Research end date: 05/2018