Regionalizing Cancer Surgery

描述（由申请人提供）：该项目旨在预测区域化两种癌症手术对患者的潜在成本和收益：胰十二指肠切除术（维普莱手术）和结肠癌切除术。较高的医院手术量与这些手术的较低死亡率相关。这些发现导致了对这些外科手术进行“区域化”的建议--也就是说，将护理集中在选定的一些地理上分散的、高容量的设施。然而，区域化将减少在每个当地市场进行手术的医院数量，导致医院竞争减少。竞争的减少可能导致65岁以下需要这些手术的患者的价格上涨。在过去的研究中，医院之间对患者的竞争较低也与医院死亡率和成本较高有关。区域化对福利的影响将取决于哪种效应占主导地位--由于数量增加而降低死亡率和成本的价值，或者价格和成本的增加，以及由于供应商整合而可能导致质量竞争的损失。该项目旨在：1）估计市场集中度增加对维普莱手术和结肠癌切除术的交易价格、成本和死亡率的影响; 2）估计手术量增加对这两种手术的住院死亡率和每位患者的成本的影响; 3）使用目标1和2的估计值来预测维普莱手术和结肠癌切除术的区域化对死亡率、成本和价格的影响;以及，4）估计这2种复杂癌症手术区域化的福利影响。结果将有重要的影响，以确定整体福利的后果，病人的区域化这两个复杂的癌症手术。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.