Cost effectiveness of regionalization-further results for heart surgery.

A recent study concluded that efficient production of heart surgeries requires a minimum volume of 500 procedures per center per year. A replication of that study, under a different set of circumstances, is reported in this paper. The geographic setting was substantially different: a west coast city in the earlier study versus a midwest suburb in the current study. The type of hospital was also substantially different: prepaid health plan-owned in the earlier study versus nonprofit fee-for-service community hospital, owned by a religious order, in the current study. Physician costs were included in the previous study but were excluded from the current study. Travel distances were included in both studies but because of the geographic setting tended to be greater in the current study. The results of the current study indicate that efficient production could be attained at a volume of 300 heart surgery patients per center per year. The difference from the results of the earlier study is attributable to the treatment of physician salaries, the hospital-specific decisions on appropriate capacity and utilization of facilities, and the greater travel distances.