Disparities in Utilization of High-Volume Hospitals for Cancer Surgery: Results of a Korean Population-Based Study

Background. Referral to high-volume hospitals has been recommended for cancer procedures with a demonstrated volume-outcome relationship. However, little is known about the factors associated with use of high-volume hospitals for cancer procedures. The purpose of this study was to determine patient characteristics associated with receipt of oncologic surgery at high-volume hospitals. Methods. Data were obtained from claims submitted to the Korean National Health Insurance System. We identified patients who underwent the following procedures between 2002 and 2005: esophagectomy, pancreatectomy, gastrectomy, colectomy, lung resection, mastectomy, and cystectomy. Each hospital volume was divided into tertiles. Patient demographic, socioeconomic, and clinical variables were investigated as factors that may affect use of high- or low-volume hospitals. Results. A total of 49,897 patients received one of the seven procedures. Trends toward lower operative risks at high-volume hospitals were observed for all procedures. Patients who were older [odds ratio (OR), 0.60-0.69], lived in a rural area (OR, 0.79), had emergent surgeries (OR, 0.39-0.85), and had lower Charlson score were less likely to go to high-volume hospitals. For all procedures, patients having the lowest income level were significantly less likely to be treated at high-volume hospitals, compared with patients having the highest income level (OR, 0.45-0.58). Conclusions. We identified substantial demographic and socioeconomic disparities in use of high-volume hospitals for the seven procedures examined. The policy for selective referral to high-volume hospitals should include explicit efforts to identify patient and system factors required to reduce current inequities.