During the eight-year period covered in this report (2002-09), there has been a reduction in geographic variations in the use of some of the health care procedures selected in this study, such as cardiac catheterisation and coronary angioplasty. There has also been a reduction in geographic variations in caesarean section rates, although the variation between public and private hospitals rates continues to be wide. The Portuguese Ministry of Health recently asked a group of experts to develop a plan to reduce the inappropriate use of caesarean sections throughout the country. This study also shows that geographic variations in the use of some other procedures that are becoming less frequently used and replaced by other treatment options are increasing, for example for coronary artery bypass graft (CABG) and hysterectomy. This indicates that the reduction in the use of these procedures has not been uniform across the countries, and a need to promote greater convergence in clinical practices.