OBJECTIVES:

Investigating variations in health care expenditures across providers can help gain insights in improving resource utilization efficiency in health care systems. Our study aimed to examine the expenditure variation of endovascular treatments for patients with lower extremity arterial disease (LEAD) among hospital departments in China and to attribute it to patient- and department-level variables.

METHODS:

We used cohort data from the VascuBase registry, where patient and clinical data were obtained from surgeons and patients in the vascular surgery departments of 10 tertiary hospitals scattered in 7 provinces. A total of 3,000 LEAD patients registered from Dec 2020 to Sept 2022. The department management was measured by the World Management Survey instrument and the department characteristics were additionally investigated. We used multilevel models to examine variation across departments in endovascular expenditure, adjusting for demographics and health status, disease severity and treatment patterns, and department characteristics and management. Log-transformed endovascular expenditure was modeled as the dependent variable.

RESULTS:

2080 patients with femoral-popliteal artery intervention were studied and the mean endovascular expenditure was $13,068 (SD=$6,003). Across 10 departments, the mean expenditure ranged from $7,839(SD=$3,335) to $15,983 (SD=$6,266) and showed significant differences (p<0.001). After fully adjusting for variables, there were no longer significant differences in expenditure across departments (range: $13,377 (SD=$2,204) to $13965 (SD=$5,256), p=0.601).

The patient-level variables explained 20.8% (1.8% for demographics and health status, 7.7% for disease severity and 11.3% for treatment patterns) of the variation while the department-level variables explained 28.0%. The random intercept effects at the department level accounted for 9.8% of the variance.

CONCLUSIONS:

Endovascular expenditure varied widely across hospital departments in China, which is partially attributed to differences in patient and clinical characteristics. However, the policy makers and hospital administrators should pay more attention to the differences in treatment patterns and hospital administration and management to further improve the service efficiency.