Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA.
Health Aff (Millwood). 2011 Aug;30(8):1569-74. doi: 10.1377/hlthaff.2010.0210. Epub 2011 Jun 23.
Despite decreasing demand for bypass surgery, 301 new cardiac surgery programs opened between 1993 and 2004. We used Medicare data to identify where the new programs opened and to assess their impact on access and efficiency. Forty-two percent of the new programs opened in communities that already had access to cardiac surgery, which suggests that their creation has led to a fight for shares of a shrinking market. New programs were much more likely to open in states that did not require them to show a certificate-of-need. Overall, travel time to the nearest cardiac surgery program changed little, which suggests that these programs have done little to improve geographic access. The duplication of services that resulted in many areas may have engendered competition based on quality, price, or both, but it may also have increased surgical rates, with unknown results. We observe that certificate-of-need requirements may help avoid unnecessary duplication of services by preventing new programs from opening in close proximity to existing ones.
尽管旁路手术的需求在减少，但 1993 年至 2004 年间仍有 301 个新的心脏手术项目开设。我们使用医疗保险数据来确定新的项目开设的地点，并评估其对可及性和效率的影响。42%的新项目开设在已经可以进行心脏手术的社区，这表明它们的开设导致了对不断缩小的市场份额的争夺。在不需要证明有医疗需求的州，新的项目更有可能开设。总的来说，到最近的心脏手术项目的旅行时间变化不大，这表明这些项目在改善地理可及性方面收效甚微。在许多地区出现的服务重复可能导致了基于质量、价格或两者的竞争，但也可能提高了手术率，其结果尚不清楚。我们观察到，医疗需求证书要求可能有助于通过防止新项目在现有项目附近开设来避免不必要的服务重复。
