Exploring geographical variation in access to general surgery in Ireland: Evidence from a national study.

BACKGROUND: Improving the equity of surgical services is an important objective of all clinical programmes both local and overseas. Variations in access to care threaten to dismantle the structural paradigm of any health service and such information can aid in promoting quality and access to surgical services. The aim of this study was to explore the geographical variation in the utilisation of common general surgical procedures in Ireland as a measure of the population's access to surgical interventions.

METHODS: Age- and gender-standardized rates for 6 common general surgical procedures were calculated for 28 geographic areas (counties) in the Republic of Ireland using data from the national Hospital Inpatient Enquiry System. Standard statistical indicators (systematic component of variation, coefficient of variation and extremal quotient) were used to measure the extent of regional variation.

RESULTS: A total of 998,406 episodes of hospital care were included in the analysis. Large variation in utilisation was present between the studied counties; CV > 0.3 (range 19.4-31.2), SCV > 5 (range 5.2-14.6). Most procedures were utilised at substantially higher rates outside the larger cities (Dublin, Galway, Waterford).

CONCLUSION: Variations stemming from inefficient and unequal access are important components and markers of modern health systems and should be minimal. County of residence appears to have a clear influence on a patients' inaccessibility to certain interventions. Our findings imply a need for improved access at a regional level by facilitating the integration of public policies and promoting services at the appropriate settings.