Regional differences in appropriateness of cholecystectomy in a prepaid health insurance system

D. Pilpel, G. M. Fraser, J. Kosecoff, S. Weitzmann, R. H. Brook

    Research output: Contribution to journalArticlepeer-review

    17 Scopus citations


    Background: Previous studies have reported variation in the population-based use rate of diagnostic and therapeutic procedures. Cholecystectomy is one of the most common surgical procedures, and we conducted this study to assess whether in Israel the use of this procedure varied by region and whether differences in use can be related to differences in appropriateness of use. In Israel, there is a pre-paid health insurance system and all surgeons are salaried. Methods: Age-adjusted rates of cholecystectomy in four hospitals, each serving a defined population in Israel, were calculated. Two hundred and sixty-six potential clinical indications for performing cholecystectomy were rated as to their appropriateness by a panel of 9 expert physicians. A trained team abstracted the medical records of all patients who underwent the operation in the four Israeli hospitals in 1986 (n = 702) and recorded the clinical indication for the surgery. Results: The population-based age-adjusted rates of cholecystectomy varied over threefold among the four hospitals. 29% of the cholecystectomies were performed for less than appropriate reasons, and this figure varied by hospital from 36% to 17% (p = 0.002). However, appropriateness did not vary systematically with the population-based use rate. Conclusion: Cholecystectomy was performed frequently for inappropriate or equivocal reasons, even in a country in which resources are limited, and physicians are salaried. Efforts to improve surgical decision making should be undertaken.

    Original languageEnglish
    Pages (from-to)61-74
    Number of pages14
    JournalPublic Health Reviews
    Issue number1-2
    StatePublished - 1 Dec 1992


    • appropriateness
    • cholecystectomy
    • regional variation

    ASJC Scopus subject areas

    • Community and Home Care
    • Public Health, Environmental and Occupational Health


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