Regionalizing Cancer Surgery (R21)

描述（由申请人提供）：本项目旨在预测两种癌症手术的潜在成本和收益：胰十二指肠切除术（惠普尔手术）和结肠癌切除术。较高的医院手术量与较低的此类手术死亡率相关。这些发现导致了对这些外科手术“区域化”的建议——也就是说，将护理集中在地理上分散的高容量设施中。然而，区域化将减少在每个地方市场开展手术的医院数量，导致医院竞争减少。竞争的减少可能会导致65岁以下患者需要这些手术的价格上涨。在过去的研究中，医院之间对病人竞争的减少也与更高的医院死亡率和更高的成本有关。区域化对福利的影响将取决于哪种影响占主导地位——是由于数量增加而降低死亡率和成本的价值，还是价格和成本的增加，以及由于供应商合并而导致的质量竞争的潜在丧失。本项目旨在：1)估计市场集中度提高对惠普尔手术和结肠癌切除术的交易价格、成本和死亡率的影响；2)估计增加的手术量对住院病人死亡率和这两种手术的人均成本的影响；3)使用目标1和目标2的估计来预测惠普尔手术和结肠癌切除术区域化对死亡率、成本和价格的影响；4)评估这两种复杂癌症手术区域化对福利的影响。研究结果将对确定这两种复杂的癌症手术对患者的总体福利影响具有重要意义。这些分析也将作为案例研究，以确定使用这些方法分析更广泛手术的价值和可行性。

DESCRIPTION (provided by applicant): This project aims to predict the potential costs and benefits to patients of regionalizing two cancer operations: pancreaticoduoenectomy (the Whipple procedure) and colon cancer resection. Higher hospital procedure volume has been associated with lower mortality rates for these operations. These findings have led to recommendations to "regionalize" these surgical procedures--that is, to concentrate care at a select number of geographically dispersed, high-volume facilities. However, regionalization will reduce the number of hospitals performing surgery in each local market, leading to reduced hospital competition. Reduced competition could lead to higher prices for patients under age 65 requiring these surgeries. In past research, lower competition for patients between hospitals has also been associated with both higher hospital mortality and higher costs. The welfare impact of regionalization will depend upon which effects dominate--the value of the reduction in mortality and costs due to increased volume, or the increase in both prices and costs, and potential loss of quality competition due to consolidation of providers. This project seeks to: 1) Estimate the impact of increased market concentration on transaction prices, costs, and mortality rates for the Whipple procedure and colon cancer resections; 2) Estimate the impact of increased procedure volume on both inpatient mortality and costs per patient for these two procedures; 3) Use estimates from Aims 1 and 2 to predict the impact of regionalization of the Whipple procedure and colon cancer resections on mortality, costs, and prices; and, 4) Estimate the welfare impact of regionalization of these 2 complex cancer surgeries. The results will have important implications for determining the overall welfare consequences to patients of regionalizing these two complex cancer operations. The analyses will also serve as case studies to determine the value and feasibility of analyzing a wider range of surgeries using these methods.