title: High-quality, low-cost gastrectomy care at high-volume hospitals: results from a population-based study in South Korea.
abstract: OBJECTIVE
  To evaluate associations among hospital volume, costs, and length of stay (LOS) and to assess whether reduced hospital cost of care adversely affected quality of care.
  
  
  METHODS
  Four-year, nationwide, population-based study.
  
  
  METHODS
  Data were obtained from claims submitted to the South Korean National Health Insurance database.
  
  
  METHODS
  We identified 48 938 patients at 274 hospitals who had undergone gastric resection from January 1, 2002, through December 31, 2005. Hospital volumes were divided into quartiles.
  
  
  METHODS
  Patient demographics and socioeconomic and clinical variables were investigated as factors that might affect costs and LOS.
  
  
  RESULTS
  Independent predictors of higher costs and longer LOS included older age, increased Charlson score, and hospitals with fewer beds. After adjusting for relevant factors, an inverse relationship between volume and costs or LOS was found such that higher-volume hospitals had the lowest procedure costs and LOS. Results showed no association between hospital cost and quality of care.
  
  
  CONCLUSIONS
  Higher hospital volume is predictive of lower costs and LOS for patients undergoing gastric resection. By referring these patients to high-volume centers, we may improve quality of care and reduce costs. Furthermore, high-quality care can be maintained when costs are lowered due to high volume.
authors.affiliation: Division of Cancer Policy and Management, National Cancer Control Research Institute, National Cancer Center, 809 Madu 1-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, South Korea.
authors.forename: Jung A
authors.initials: JA
authors.lastname: Lee
authors.forename: Jong Hyock
authors.initials: JH
authors.lastname: Park
authors.forename: Eun Jung
authors.initials: EJ
authors.lastname: Lee
authors.forename: So Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Yoon
authors.initials: Y
authors.lastname: Kim
authors.forename: Sang Il
authors.initials: SI
authors.lastname: Lee
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D056910:Republic of Korea