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Competition Wins Over Centralization

MANAGED CARE March 2007. © MediMedia USA
News and Commentary

Competition Wins Over Centralization

MANAGED CARE March 2007. ©MediMedia USA

Insurers who recommend a particular provider or health care organization to a patient considering a surgical procedure need to determine how complex the procedure is and how frequently the surgeon performs the procedure.

If the procedure is fairly common, like bypass graft surgery or coronary artery surgery, chances are good that a high-volume provider and health care facility can deliver the best outcome.

However, some researchers and policymakers go so far as to recommend the regionalization of complex surgeries, arguing that by concentrating these surgeries at a few geographically dispersed high-volume facilities and eliminating low-volume facilities and providers, better patient outcomes can be expected.

Outcome data from hospitals in Florida, New Jersey, and New York suggest that patients who underwent a clinically complex operation called the Whipple technique, the most common surgical procedure for difficult-to-treat pancreatic cancer, "would be better off going to hospitals that perform this surgery often, rather than low-volume hospitals," says Vivian Ho, PhD, an associate professor of medicine at Baylor College of Medicine.

But limiting the number of providers also runs the risk of triggering a monopoly effect, says Ho.

Still, "When it comes to surgeries that involve very complex procedures, the higher benefit is seen if the procedure is performed by surgeons and hospitals that have performed more of them," says Ho.

"The managed care company needs to ask [of a hospital], 'How many procedures are performed at the facility and how many procedures has the surgeon performed?'" says Ho.

The study was published in the journal of Health Economics, Policy, and Law.