Geographic variation of hysterectomy rates in the Israeli health care system during the years 2007–2016

BACKGROUND: In 2014 the OECD published a report regarding inter-regional variation of hysterectomies in 13 countries including Israel. Variance in hospital admission rates were also reported. The Israeli Ministry of Health has set as one of its main goals the reduction in differences in health care, particularly between the country’s periphery and central regions. These variations may reflect differences in characteristics, resource allocation, and medical staff employment, expertise and training. The advances in technology in the last decades including laparoscopic and robotic surgeries and the variance in their implementation emphasize the great regional variance. The aim of this study was to examine hysterectomy trends in the past decade with emphasis on regional differences. METHODS: The study is based on information maintained by the Israeli Ministry of Health and portrays the trend in hysterectomy rates as a factor of indication, surgical approach and length of hospitalization as collected from the years 2007–2016. RESULTS: Inter-regional significant differences were found between the 7 regions of Israel, though there was a clear trend toward a national 11–24% decrease in hysterectomy rates. A 2–4 time increase in laparoscopic hysterectomies was observed. There was a clear country-wide trend toward shortening hospital stay from 5 to 4 days in total. CONCLUSIONS: Hysterectomy rates have declined in the past decade due to the implementation of new technologies allowing earlier diagnosis and minimally invasive surgery on top of offering alternative, non-surgical treatment modalities. Uneven allocation of resources and manpower allowing technology implementation and optimal medical services may have contributed to the findings.