New York University School of Medicine, New York City, USA.
Health Aff (Millwood). 2012 Apr;31(4):730-40. doi: 10.1377/hlthaff.2011.0336.
Policy makers interested in containing health care costs are targeting regional variation in utilization, including the use of advanced imaging. However, bluntly decreasing utilization among the highest-utilization regions may have negative consequences. In a cross-sectional study of prostate cancer patients from 2004 to 2005, we found that regions with lower rates of inappropriate imaging also had lower rates of appropriate imaging. Similarly, regions with higher overall imaging rates tended to have not only higher rates of inappropriate imaging, but also higher rates of appropriate imaging. In fact, men with high-risk prostate cancer were more likely to receive appropriate imaging if they resided in areas with higher rates of inappropriate imaging. This "thermostat model" of regional health care utilization suggests that poorly designed policies aimed at reducing inappropriate imaging could limit access to appropriate imaging for high-risk patients. Health care organizations need clearly defined quality metrics and supportive systems to encourage appropriate treatment for patients and to ensure that cost containment does not occur at the expense of quality.
政策制定者关注医疗成本控制，针对的是利用方面的区域差异，包括使用先进的成像技术。然而，简单地降低利用率最高的地区的利用率可能会产生负面影响。在对 2004 年至 2005 年前列腺癌患者的横断面研究中，我们发现成像不合适率较低的地区，成像合适率也较低。同样，整体成像率较高的地区不仅不合适成像率较高，合适成像率也较高。事实上，如果高危前列腺癌患者居住在成像不合适率较高的地区，他们更有可能接受合适的成像。这种区域医疗利用的“恒温器模型”表明，设计不良的旨在减少不合适成像的政策可能会限制高危患者获得合适成像的机会。医疗保健组织需要明确的质量指标和支持系统，以鼓励为患者提供适当的治疗，并确保成本控制不会以牺牲质量为代价。
