About Healthcare Variation

Why measure variation in health care use?

Getting the best outcomes for patients and reducing harm are the goals of the Australian Atlas of Healthcare Variation series. Where we see substantial variation in use of a particular treatment, it is an alarm bell that should make us stop and investigate whether appropriate care is being delivered.

Variation in itself is not necessarily bad, and it can be good if it reflects health services responding to differences in patient preferences or underlying needs. When a difference in the use of health services does not reflect these factors, it is unwanted variation and represents an opportunity for the health system to improve.

Rates of an intervention that are substantially higher or lower in some areas can highlight:

Inequity of access to evidence-based care, and the need to deliver services more fairly
Uncertainty about the intervention’s place in therapy, and the need for better data on its benefits and harms
Gaps in accessible evidence for clinicians, and the need for clinical care standards
Inadequate system supports for appropriate care, and the need for changes in training or financial incentives.

Looking at how healthcare use varies between people living in different areas, between people with and without socioeconomic disadvantage, and between Aboriginal and Torres Strait Islander Australians and other Australians can show who in our community is missing out. Fundamental changes to address the underlying determinants of ill health, as well as better service delivery for those with existing disease, are needed where these inequities are found.

The Atlas of Healthcare Variation series

Maps of variation in care, derived from information routinely gathered by the health system, show how healthcare use differs across the country and to raise important questions about why this variation might be occurring. The aim is to prompt further investigation into whether the observed variation reflects differences in people’s healthcare needs, in the informed choices they make about their treatment options, or in other factors.

Find out more on the Atlas series here:

The first Atlas was published in 2015 and focused on care related to antibiotic prescribing, surgical, mental health and diagnostic services.
The second Atlas, released in 2017, examined chronic disease and infection – potentially preventable hospitalisations, cardiovascular conditions, women’s health and maternity and surgical interventions.
The third Atlas published in 2018 examined neonatal and paediatric health, thyroid and gastrointestinal investigations and treatments and cardiac tests. It also focused on changes over time in prescribing behaviour, with a repeat analysis of prescribing over four years for antimicrobial, opioid and psychotropic medicines.

NSQHS Standards Action 1.28 on clinical variation

The value of monitoring clinical variation is now reflected in the National Safety and Quality Health Service (NSQHS) Standards. Developed by the Commission in collaboration with the Australian Government, states and territories, the private sector, clinical experts, patients and carers, the NSQHS Standards aim to protect the public from harm and to improve the quality of health service provision.

The Clinical Governance Standard: Action 1.28 variation in clinical practice requires health service organisations to have systems in place that use data to monitor variation in care to identify unwarranted variation and to regularly review and improve the appropriateness of clinical care.