Initial steps for the Portuguese Atlas of geographical variation in healthcare

Non-clinical aspects contribute to differences in healthcare practices within each country, which may imply that some patients do not receive the care they need. In contrast, others may not benefit from the care that they receive. However, to the authors' knowledge, only a few geographical variation studies with a national scope were recently conducted in Portugal. This study aimed to test if it was possible to conduct a geographical variation analysis in Portugal using publicly available data to compare the 18 districts and stimulate a debate around this topic. To achieve this goal, we first investigated the publicly available Portuguese National Health Service database (Transparency Portal) for data from activities and procedures that could be included in this analysis. Four were included: percentage of cesarian sections in total births, rate of hip surgeries within the first 48 h after admission in patients older than 65, rate of consumed antibiotics in the total drugs consumed, and percentage of elective surgeries. After retrieving the data, we mapped the results and computed the ratio of variation and the coefficient of variation. Finally, we discussed the results with medical doctors, public health researchers, and health economists. Results suggested geographical variation mainly in the rate of hip surgeries performed 48 h after admission (from 18.53% to 83.64%). Overall, the results highlighted the need for a national benchmarking system to span this analysis to other activities and initiate a broader discussion with patients, clinicians, providers, and policymakers.