Health Affairs

Posting date: October 7, 2004

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Health Affairs, 10.1377/hlthaff.var.45
Copyright © 2004 by Project HOPE

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Regional Availability Of High-Volume Hospitals For Major Surgery

Justin B. Dimick ^1*, Samuel R.G. Finlayson ², John D. Birkmeyer ³

¹ Justin Dimick is a postdoctoral research fellow in the Veteran’s Affairs (VA) Outcomes Group, VA Medical Center, in White River Junction, Vermont.
² Samuel Finlayson is an assistant professor of surgery in the Veteran’s Affairs (VA) Outcomes Group, VA Medical Center, in White River Junction, Vermont.
³ John Birkmeyer is the George D. Zuidema Professor and Chair, Surgical Outcomes Research, University of Michigan Medical Center, in Ann Arbor.

^*Corresponding author.

Abstract

Despite evidence of increased risks, a large number of patients still have surgery in low-volume hospitals. To better understand why, we used Medicare data to study the regional availability of high-volume hospitals. More than half of patients undergoing three procedures in low-volume hospitals lived in regions lacking a high-volume hospital. Some regions simply lacked enough cases to support a high-volume hospital. Other regions had enough cases but too many hospitals performing them. Although consolidation of surgical services may be feasible in some settings, volume-based referral strategies are impractical for many U.S. regions.

Key Words: Access To Care, Consumer Issues, Medicare, Quality Of Care, Variations

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