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01.11.2010 | Healthcare Policy and Outcomes | Ausgabe 11/2010

Annals of Surgical Oncology 11/2010

Disparities in Utilization of High-Volume Hospitals for Cancer Surgery: Results of a Korean Population-Based Study

Annals of Surgical Oncology > Ausgabe 11/2010
MD So Young Kim, MD, MPH, PhD Jong Hyock Park, MPH Sung Gyeong Kim, MPH Hye Kyung Woo, MD, PhD Jae Hyun Park, MD, PhD Yoon Kim, MD, PhD Eun Cheol Park



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.


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.


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).


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.

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