Centralization of care in high volume hospitals and inequalities in access to care

Huguet, Marius

doi:10.1016/j.socscimed.2020.113177

Cited by 19 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, centralized care at the nearest high-volume hospital requires that patients are no longer given the option of choosing their preferred provider. In health systems where patients have the option of choosing their hospital (e.g., France, the United Kingdom, and the United States), it has been shown that ignoring patient preferences when assessing the impact of such policies drastically underestimates the deterioration in patient access to care [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

What underlies the observed hospital volume-outcome relationship?

Huguet

Joutard

Ray‐Coquard

et al. 2022

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background Studies of the hospital volume-outcome relationship have highlighted that a greater volume activity improves patient outcomes. While this finding has been known for years, most studies to date have failed to delve into what underlies this relationship. Objective This study aimed to shed light on the basis of the hospital volume effect on patient outcomes by comparing treatment modalities for epithelial ovarian carcinoma patients. Data An exhaustive dataset of 355 patients in first-line treatment for Epithelial Ovarian Carcinoma (EOC) in 2012 in three regions of France was used. These regions account for 15% of the metropolitan French population. Methods In the presence of endogeneity induced by a reverse causality between hospital volume and patient outcomes, we used an instrumental variable approach. Hospital volume of activity was instrumented by the distance from patients’ homes to their hospital, the population density, and the median net income of patient municipalities. Results Based on our parameter estimates, we found that the rate of complete tumor resection would increase by 15.5 percentage points with centralized care, and by 8.3 percentage points if treatment decisions were coordinated by high-volume centers compared to decentralized care. Conclusion As volume alone is an imperfect correlate of quality, policy-makers need to know what volume is a proxy for in order to devise volume-based policies.

show abstract

Section: Discussionmentioning

confidence: 99%

What underlies the observed hospital volume-outcome relationship?

Huguet

Joutard

Ray‐Coquard

et al. 2022

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Cancer care is entirely covered by the French public health insurance system. Despite the existence of geographical disparities (Huguet 2020), cancer patients have access to Comprehensive Cancer Centers (CCCs), University Hospitals (CHU), and public or private hospitals which have specific authorisation from the French Cancer Institute to treat cancer. French patients can choose where to be treated, but the fully reimbursement of the cost of transport to a hospital for treatment is spatially limited to the specialised hospital or clinic closest to the patient's home.…”

Section: A Singular Therapeutic Itinerarymentioning

confidence: 99%

Chronicity and the patient’s decision-making work. The case of an advanced cancer patient

Besle

Sarradon-Eck

2022

Anthropology & Medicine

View full text Add to dashboard Cite

We would like to thank Dominique (Patrick's wife) and his son Leo for their time and trust in answering our questions. Their names have been changed to respect the rules of anonymity in social science research. We also thank Juliette Sakoyan who conducted Patrick's interview in 2008, and Dr Jessica Blanc for translating the original version of this paper into English. The manuscript benefited from comments by Cinzia Greco and Nils Graber. We are also grateful to the anonymous reviewers for their helpful suggestions on various iterations of this paper. In accordance with local legislation, this work has not been subject to ethical review.

show abstract

“…Whether or not the centralisation of health services should be adopted as a strategy to facilitate population health promotion is a study focus both for policy-making and research purposes. [1][2][3][4][5][6] Centralisation policy for resource allocation also is described as 'concentration' or 'regionalization'. 7 8 Volume-outcome is the basis for promoting centralisation policy.…”

Section: Introductionmentioning

confidence: 99%

The causal effect of delivery volume on severe maternal morbidity: an instrumental variable analysis in Sichuan, China

Chen

Pan

2022

BMJ Glob Health

View full text Add to dashboard Cite

ObjectiveFindings regarding the association between delivery volume and maternal health outcomes are mixed, most of which explored their correlation. This study aims to demonstrate the causal effect of delivery volume on severe maternal morbidity (SMM) in China.MethodsWe analysed all women giving birth in the densely populated Sichuan province with 83 million residents in China, during the fourth quarters of each of 4 years (from 2016 to 2019). The routinely collected discharge data, the health institutional annual report data and road network data were used for analysis. The maternal health outcome was measured by SMM. Instrumental variable (IV) methods were applied for estimation, while the surrounding average number of delivery cases per institution was used as the instrument.ResultsThe study included 4545 institution-years of data from 1456 distinct institutions with delivery services, reflecting 810 049 associated delivery cases. The average SMM rate was approximately 33.08 per 1000 deliveries during 2016 and 2019. More than 86% of delivery services were provided by a third of the institutions with the highest delivery volume (≥143 delivery cases quarterly). In contrast, less than 2% of delivery services were offered by a third of the institutions with the lowest delivery volume (<19 delivery cases quarterly). After adjusting the confounders in the IV-logistic models, the average marginal effect of per 1000 cases in delivery volume was −0.162 (95% CI −0.169 to –0.155), while the adjusted OR of delivery volume was 0.005 (95% CI 0.004 to 0.006).ConclusionIncreased delivery volume has great potential to improve maternal health outcomes, while the centralisation of delivery services might facilitate maternal health promotion in China. Our study also provides implications for other developing countries confronted with similar challenges to China.

show abstract

Centralization of care in high volume hospitals and inequalities in access to care

Cited by 19 publications

References 19 publications

What underlies the observed hospital volume-outcome relationship?

What underlies the observed hospital volume-outcome relationship?

Chronicity and the patient’s decision-making work. The case of an advanced cancer patient

The causal effect of delivery volume on severe maternal morbidity: an instrumental variable analysis in Sichuan, China

Contact Info

Product

Resources

About