Extent, regional variation and impact of gynecologist payment models in routine pelvic examinations: a nationwide cross-sectional study

BMC Women's Health

Research Article

Linda Leivseth¹  Olav Helge Førde²  Ingvild Mathiesen Rosenlund³  Arthur Revhaug⁴  Ingard Nilsen⁵ 

[1] Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway;Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, Tromsø, Norway;Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway;Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway;Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway;Division of Surgery, Oncology and Women’s Health, University Hospital of North Norway, Tromsø, Norway;Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway;

关键词: Routine pelvic examination;    Unwarranted examination;    Fee-for-service;    Regional variation;    Ultrasonography;    Colposcopy;   

DOI  :  10.1186/s12905-017-0471-2

 received in 2017-09-15, accepted in 2017-11-13,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundBased on moderate quality evidence, routine pelvic examination is strongly recommended against in asymptomatic women. The aims of this study was to quantify the extent of routine pelvic examinations within specialized health care in Norway, to assess if the use of these services differs across hospital referral regions and to assess if the use of colposcopy and ultrasound differs with gynecologists’ payment models.MethodsNationwide cross-sectional study including all women aged 18 years and older in Norway in the years 2014–16 (2,038,747). Data was extracted from the Norwegian Patient Registry and Statistics Norway. The main outcome measures were 1. The number of appointments per 1000 women with a primary diagnosis of “Encounter for gynecological examination without complaint, suspected or reported diagnosis.” 2. The age-standardized number of these appointments per 1000 women in the 21 different hospital referral regions of Norway. 3. The use of colposcopy and ultrasound in routine pelvic examinations, provided by gynecologists with fixed salaries and gynecologists paid by a fee-for-service model.ResultsAnnually 22.2 out of every 1000 women in Norway had a routine pelvic examination, with variation across regions from 6.6 to 43.9 per 1000. Gynecologists with fixed salaries performed colposcopy in 1.6% and ultrasound in 74.5% of appointments. Corresponding numbers for fee-for-service gynecologists were 49.2% and 96.2%, respectively.ConclusionsRoutine pelvic examinations are widely performed in Norway. The variation across regions is extensive. Our results strongly indicate that fee-for-service payments for gynecologists skyrocket the use of colposcopy and increase the use of ultrasound in pelvic examinations of asymptomatic women.

【 授权许可】

CC BY   
© The Author(s). 2017