Within and across country variations in treatment of patients with heart failure and diabetes

Or, Zeynep; Shatrov, Kosta; Penneau, Anne; Wodchis, Walter; Abiona, Olukorede; Blankart, Carl Rudolf; Bowden, Nicholas; Bernal‐Delgado, Enrique; Knight, Hannah; Lorenzoni, Luca; Marino, Alberto; Papanicolas, Irene; Riley, Kristen; Pellet, Leila; Estupiñán‐Romero, Francisco; Gool, Kees; Figueroa, Jose F. (2021). Within and across country variations in treatment of patients with heart failure and diabetes. Health Services Research, 56 Suppl 3(Suppl 3), pp. 1358-1369. Wiley 10.1111/1475-6773.13854

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To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries.

Data Sources
Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States.

Data Collection Methods
Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016.

Study Design
We calculated the care consumption of patients after a hospital admission over a year across the care pathway—ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female–male ratios for eight utilization and spending measures.

Principal Findings
In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27–0.36), while it is, 0.50 (0.45–0.56) for primary care visits, and more than 0.75 (0.81–0.92) for rehabilitation use and nurse visits at home (0.78; 0.62–0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01–1.06), have a higher number of prescriptions (+7%, 1.05–1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79–1.6, 0.99–1.64), but have fewer visits to specialists (−10%; 0.84–0.97).

Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Faculty Institutions > sitem Center for Translational Medicine and Biomedical Entrepreneurship > Healthcare Regulation and Management
11 Centers of Competence > KPM Center for Public Management

UniBE Contributor:

Shatrov, Kosta Donislavov, Blankart, Rudolf


300 Social sciences, sociology & anthropology > 350 Public administration & military science






[UNSPECIFIED] The Commonwealth Fund, NY, USA ; [UNSPECIFIED] The Health Foundation, UK




Carl Rudolf Berchtold Blankart

Date Deposited:

04 Oct 2021 13:46

Last Modified:

02 Mar 2023 23:35

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