Disparities in utilization of high-volume hospitals for cancer surgery: results of a Korean population-based study.
BACKGROUND
Referral to high-volume hospitals has been recommended for cancer procedures with a demonstrated volume-outcome relationship. However, little is known about the factors associated with use of high-volume hospitals for cancer procedures. The purpose of this study was to determine patient characteristics associated with receipt of oncologic surgery at high-volume hospitals.


METHODS
Data were obtained from claims submitted to the Korean National Health Insurance System. We identified patients who underwent the following procedures between 2002 and 2005: esophagectomy, pancreatectomy, gastrectomy, colectomy, lung resection, mastectomy, and cystectomy. Each hospital volume was divided into tertiles. Patient demographic, socioeconomic, and clinical variables were investigated as factors that may affect use of high- or low-volume hospitals.


RESULTS
A total of 49,897 patients received one of the seven procedures. Trends toward lower operative risks at high-volume hospitals were observed for all procedures. Patients who were older [odds ratio (OR), 0.60-0.69], lived in a rural area (OR, 0.79), had emergent surgeries (OR, 0.39-0.85), and had lower Charlson score were less likely to go to high-volume hospitals. For all procedures, patients having the lowest income level were significantly less likely to be treated at high-volume hospitals, compared with patients having the highest income level (OR, 0.45-0.58).


CONCLUSIONS
We identified substantial demographic and socioeconomic disparities in use of high-volume hospitals for the seven procedures examined. The policy for selective referral to high-volume hospitals should include explicit efforts to identify patient and system factors required to reduce current inequities.
National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do, Republic of Korea.
So Young
SY
Kim
Jong Hyock
JH
Park
Sung Gyeong
SG
Kim
Hye Kyung
HK
Woo
Jae Hyun
JH
Park
Yoon
Y
Kim
Eun Cheol
EC
Park
D000368:Aged; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D056910:Republic of Korea; D012959:Socioeconomic Factors