Market and Regulatory Influences on the Availability of Coronary Angioplasty and Bypass Surgery in U.S. Hospitals

Abstract

Using 1983 data on 3720 nonfederal short-term hospitals, we analyzed the influence of local market competition and state regulatory programs on the availability of percutaneous transluminal coronary angioplasty and coronary-artery bypass surgery. The degree of competition for patients with heart disease was measured in terms of the number of hospitals in the local market area that maintained a cardiac catheterization laboratory or facility for open-heart surgery. When the patient case mix and the hospital's teaching role were controlled for, institutions with more than 20 competitors in the local area were 166 percent more likely to offer coronary angioplasty (P<0.0001) and 147 percent more likely to offer bypass surgery (P<0.0001) than hospitals with no competitors in the local market. Four fifths of the hospitals performing bypass surgery whose annual volume was less than 200 had one or more neighboring hospitals with a facility for open-heart surgery. State rate-regulation programs in New York, New Jersey, Connecticut, Massachusetts, and Maryland significantly reduced the availability of both procedures, with the greatest regulatory effects being observed in the most competitive hospital markets. We conclude that in the period under consideration, competition encouraged and regulation discouraged the proliferation of these cardiac services. (N Engl J Med 1987;317:85–90.), A NUMBER of studies123456 have documented a strong inverse relation between the number of selected cardiac procedures performed in individual hospitals and the case fatality rates in those institutions. These findings suggest that a policy of regionalization, under which physicians would refer patients needing such services to institutions performing a large number of them, could reduce overall mortality. Substantial economic savings might also result from this process. Regionalization policies must, however, take into account the distance to the nearest high-volume institution when the closing of a service at a low-volume institution is being considered. Long distances between high- and low-volume… © 1987, Massachusetts Medical Society. All rights reserved.