Bergman Alon, David Guy, Nathan Ashwin, Giri Jay, Ryan Michael, Chikermane Soumya, Thompson Christin, Clancy Seth, Gunnarsson Candace
Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA 19104, USA.
Health Care Management Department, The Wharton School, University of Pennsylvania, Philadelphia, PA 19104, USA.
Health Aff Sch. 2024 Nov 6;2(11):qxae142. doi: 10.1093/haschl/qxae142. eCollection 2024 Nov.
Geographic disparities in access to inpatient procedures are a significant issue within the US healthcare system. This study introduces the Procedure Access Inequality (PAI) index, a standardized metric to quantify these disparities while adjusting for disease prevalence. Using data from the Healthcare Cost and Utilization Project State Inpatient Databases, we analyzed inpatient procedure data from 18 states between 2016 and 2019. The PAI index reveals notable variability in access inequality across different procedures, with minimally invasive and newer procedures exhibiting higher inequality. Key findings indicate that procedures such as skin grafts and minimally invasive gastrectomy have the highest PAI scores, while cesarean sections and percutaneous coronary interventions have the lowest. The study highlights that higher inequality is associated with greater market concentration and in particular, fewer hospitals offering these procedures. These findings emphasize the need for targeted policy interventions to address procedural access disparities to promote more equitable healthcare delivery across the United States.
在美国医疗保健系统中，住院手术可及性方面的地域差异是一个重大问题。本研究引入了手术可及性不平等（PAI）指数，这是一种标准化指标，用于在调整疾病患病率的同时量化这些差异。利用医疗成本与利用项目州住院数据库的数据，我们分析了2016年至2019年期间18个州的住院手术数据。PAI指数显示，不同手术的可及性不平等存在显著差异，微创手术和较新的手术表现出更高的不平等。主要研究结果表明，诸如植皮术和微创胃切除术等手术的PAI得分最高，而剖宫产术和经皮冠状动脉介入治疗的得分最低。该研究强调，更高的不平等与更大的市场集中度相关，特别是提供这些手术的医院较少。这些发现强调了需要有针对性的政策干预措施来解决手术可及性差异问题，以促进美国各地更公平的医疗服务提供。
