Delivering Quality to Patients
- Samuel R. G. Finlayson, MD, MPH
- Author Affiliations: Department of Surgery, Dartmouth Medical School, Hanover, NH; and VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vt.
- Corresponding Author: Samuel R. G. Finlayson, MD, MPH, One Medical Center Drive, Lebanon, NH 03756 (samuel.r.g.finlayson{at}hitchcock.org).
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- HEALTH SERVICES ACCESSIBILITY
- HOSPITALS
- MINORITY GROUPS
- QUALITY OF HEALTH CARE
- SURGICAL PROCEDURES, OPERATIVE
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 other options (because of lack …
