Dealing with geographic variations in the use of hospitals. The experience of the Maine Medical Assessment Foundation Orthopaedic Study Group.
ABSTRACT Orthopaedists and other physicians in Maine organized the Maine Medical Assessment Foundation to deal with the problem of variations in the rates of hospitalization for orthopaedic conditions. Five musculoskeletal injuries and five orthopaedic procedures were selected for study. The variation in decision-making by orthopaedists was least for fractures of the ankle and fractures of the hip and was greatest for fractures of the forearm, derangement of the knee, and lumbosacral sprain. The rates in an area tended to be consistently high or low for the same treatments. The major reasons for the variations appeared to be related to lack of agreement about optimum treatment. Feedback of data to physicians on variations in patterns of practice reduced the variations.
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ABSTRACT: The study systematically describes the frequency and geographic variability of major surgical interventions for musculoskeletal disorders in Switzerland. Age- and sex-standardized rates for joint replacements, arthroscopies, spine surgery and hip fracture repair were calculated for hospital service regions. Various statistical analyses were used to measure the extent of variation. The authors argue that the surgery of hip fractures can be used as index surgery in the context of analyzing variations in orthopedic surgery. Temporal trends imply that patient demand and supply factors related to clinical ambiguity and non-medical incentives of providers are far more important components leading to increased use than the sole effect of an aging population.Health & Place 02/2009; 15(3):761-8. DOI:10.1016/j.healthplace.2008.12.009 · 2.44 Impact Factor
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ABSTRACT: In canada, health care is publicly insured and available to all at no charge. Recently, financial pressures have threatened the system and led to considerable debate about how to save it. One proposal is to permit privately funded health care alongside the public system, resulting in what is popularly called a two-tiered system. This paper presents some of the arguments for and against two-tiered health care. Using as an example cataract surgery-a procedure that is available both publicly and privately-the authors look at some common beliefs about private health care in Canada. They conclude that the growth in private sector cataract surgery does not appear to be related to cutbacks or rationing, that private access does not necessarily shorten waiting times, and that, contrary to popular belief, it is not only the well-to-do who pay for private surgery in Canada.Public Health Reports 112(4):298-305; discussion 306-7. · 1.64 Impact Factor
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ABSTRACT: The authors examine the effectiveness of using hospital discharge data in assessing trends and geographic variations in the occurrence of selected chronic diseases. The Chronic Disease Surveillance System, in place from 1987 to 1991, used hospital discharge data, and Cancer Registry data to tract selected chronic diseases. The authors reviewed data on three diseases: breast cancer, cervical cancer, and lung cancer. A computerized algorithm was used to link multiple records representing a single disease occurrence. To estimate disease occurrence rates from hospital discharge data, repeat admissions for the same disease in any given calendar year were discounted. All rates were directly age-adjusted to the 1985 Maine state population. For all three diseases, the rates obtained from hospital discharge data were higher than Cancer Registry rates. Possible causes for the discrepancies and suggestions for improving the utility of hospital discharge data for chronic disease surveillance are discussed.Public Health Reports 111(1):78-81. · 1.64 Impact Factor