title: The association of hospital spending intensity and cancer outcomes: a population-based study in an Asian country.
abstract: BACKGROUND
  Different results are reported for the relationship between regional variation in medical spending and disease prognosis for acute illness and for cancer. Our objective was to investigate the association between hospital medical care spending intensity and mortality rates in cancer patients.
  
  
  METHODS
  A total of 80,597 patients with incident cancer diagnosed in 2002 were identified from the National Health Insurance Research Database of Taiwan, Republic of China. The Cox proportional hazards model was used to compare the 5-year survival rates of patients treated at hospitals with different spending intensities after adjusting for possible confounding and risk factors.
  
  
  RESULTS
  After adjustment for patient characteristics, treatment modality, and hospital volume, an association was found between lower hospital spending intensity and poorer survival rates. The 5-year survival rate expressed by hazard ratios was 1.36 (95% confidence interval [CI]: 1.30-1.43, p < .001) for colorectal cancer, 1.18 (95% CI: 1.08-1.29, p < .001) for lung cancer, 1.13 (95% CI: 1.05-1.22, p = .002) for hepatoma, 1.16 (95% CI: 1.07-1.26, p < .001) for breast cancer, and 1.23 (95% CI: 1.10-1.39, p = .001) for prostate cancer.
  
  
  CONCLUSIONS
  Our preliminary findings indicate that higher hospital spending intensity was associated with lower mortality rates in patients being treated for lung cancer, breast cancer, colorectal cancer, prostate cancer, hepatoma, or head and neck cancer. The cancer stages were unavailable in this series, and more research linked with the primary data may be necessary to clearly address this issue.
authors.affiliation: Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China.
authors.forename: Ting-Shou
authors.initials: TS
authors.lastname: Chang
authors.affiliation: Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China.
authors.forename: Kuang-Yung
authors.initials: KY
authors.lastname: Huang
authors.affiliation: Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China.
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Chang
authors.affiliation: Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China.
authors.forename: Chun-Hsuan
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China hematcd@hotmail.com hepatoma@ms3.hinet.net.
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Su
authors.affiliation: Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China; Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; Division of Rheumatology, Department of Internal Medicine, Department of Surgery, Department of Medical Research, Division of Hematology-Oncology, Department of Internal Medicine, Department of Otolaryngology, Center for Clinical Epidemiology and Biostatistics, and Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, Republic of China; School of Medicine, Tzu Chi University, Hualian, Taiwan, Republic of China; Department of Life Science and Institute of Molecular Biology, National Chung Cheung University, Chiayi, Taiwan, Republic of China hematcd@hotmail.com hepatoma@ms3.hinet.net.
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001208:Asia; D001943:Breast Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology; D015179:Colorectal Neoplasms / Q000191:economics / Q000401:mortality* / Q000473:pathology; D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate
keywords: Cancer; Cox proportional hazards model; Hospital spending intensity; Survival rate