title: Will volume-based referral strategies reduce costs or just save lives?
abstract: Although recent policy initiatives aimed at concentrating selected surgical procedures in high-volume hospitals may reduce mortality, their economic implications have not been considered fully. From the hospital perspective, the primary effect of these policies will be to redistribute surgical profits to bigger centers. From the payer perspective, prices paid for procedures will likely increase in some geographic areas. From the societal perspective, how these policies will affect the true cost of providing surgical care is uncertain, but use of discretionary procedures will likely increase. For these reasons, the primary argument for volume-based referral strategies should be improving quality, not reducing costs.
authors.forename: John D
authors.initials: JD
authors.lastname: Birkmeyer
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Skinner
authors.forename: David E
authors.initials: DE
authors.lastname: Wennberg
mesh_terms: D004469:Economics, Hospital / Q000706:statistics & numerical data / Q000639:trends*; D006302:Health Services Research; D017722:Hospital Charges; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D009511:New England; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics*; D013503:Surgery Department, Hospital / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000191:economics* / Q000401:mortality / Q000706:statistics & numerical data*; D014481:United States