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Samuel R. G. Finlayson, MD, MPH

JAMA. 2006;296:2026-2027.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In this issue of JAMA, Liu and colleagues¹ report that for several surgical procedures, a disproportionately small number of ethnic minorities and poorly insured patients receive care in high-volume hospitals, where quality of care is assumed to be superior. The authors suggest that there is a need for explicit measures to address this disparity. Although intuitively appealing, the authors' observations and suggestions implicitly embrace 2 assumptions that deserve closer scrutiny: (1) ethnic minority and poorly insured patients would want to go to high-volume hospitals if they knew the benefits and could overcome barriers to access, and (2) volume-based referral policies are a good way to improve surgical quality.

The easiest explanations for why ethnic minority and poorly insured patients are less likely to use high-volume hospitals are that they cannot (because of barriers to access) or that they may not be aware of . . . [Full Text of this Article]

Author Affiliations: Department of Surgery, Dartmouth Medical School, Hanover, NH; and VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vt.

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