Wennberg J E, Freeman J L, Culp W J
Lancet. 1987 May 23;1(8543):1185-9. doi: 10.1016/s0140-6736(87)92152-0.
The populations of New Haven and Boston are demographically similar and receive most of their hospital care in university hospitals, but in 1982 their expenditures per head for inpatient care were $451 and $889, respectively. The 685,400 residents of Boston incurred about $300 million more in hospital expenditures and used 739 more beds than they would have if the use rates for New Haven residents had applied. Most of the extra beds were invested in higher admission rates for medical conditions in which the decision to admit can be discretionary. The overall rates for major surgery were equal, but rates for some individual operations varied widely. These findings indicate that academic standards of care are compatible with widely varying patterns of practice and that medical care costs are not necessarily high in communities served largely by university hospitals. They also emphasise the need for increased attention to the outcome and cost implications of differences in practice styles.
纽黑文和波士顿的人口在人口统计学特征上相似，且大多在大学医院接受医疗护理，但在1982年，它们的人均住院护理费用分别为451美元和889美元。波士顿的68.54万居民的住院费用比按照纽黑文居民的使用率计算多出约3亿美元，且多使用了739张床位。大部分额外的床位用于那些在入院决策上具有一定随意性的医疗状况的更高入院率。大手术的总体比率相同，但某些个别手术的比率差异很大。这些发现表明，学术护理标准与广泛不同的医疗实践模式是相容的，而且在主要由大学医院服务的社区中，医疗护理成本不一定很高。它们还强调需要更加关注医疗实践方式差异对结果和成本的影响。
