New cardiac surgery programs established from 1993 to 2004 led to little increased access, substantial duplication of services.

Document Type

Article

Publication Date

8-1-2011

Institution/Department

Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute

Journal Title

Health affairs (Project Hope)

MeSH Headings

Aged, Aged, 80 and over, Efficiency, Organizational, Female, Health Services Accessibility, Humans, Insurance Claim Review, Male, Medicare, Program Evaluation, Thoracic Surgery, United States

Abstract

Despite decreasing demand for bypass surgery, 301 new cardiac surgery programs opened between 1993 and 2004. We used Medicare data to identify where the new programs opened and to assess their impact on access and efficiency. Forty-two percent of the new programs opened in communities that already had access to cardiac surgery, which suggests that their creation has led to a fight for shares of a shrinking market. New programs were much more likely to open in states that did not require them to show a certificate-of-need. Overall, travel time to the nearest cardiac surgery program changed little, which suggests that these programs have done little to improve geographic access. The duplication of services that resulted in many areas may have engendered competition based on quality, price, or both, but it may also have increased surgical rates, with unknown results. We observe that certificate-of-need requirements may help avoid unnecessary duplication of services by preventing new programs from opening in close proximity to existing ones.

ISSN

1544-5208

First Page

1569

Last Page

1574

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