Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
권호 표지
DOI QR코드

DOI QR Code

Small Area Variation in Rates of Common Surgery in General Surgery Department

일반외과 영역 다빈도 수술률의 소규모 지역간 변이

  • Published : 2004.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

This study was performed to investigate small area variation in rates of three common surgeries in general surgery department across 156 small areas. Three surgery rates were analyzed; Anal and/or stomal procedures, inguinal and/or femoral hernia procedures, appendectomy. Methods: We used health insurance claims data and the number of patients were 13,845, 2,154 and 7,151 persons respectively. Surgery rates were directly standardized with age and sex and logistic regression was used to analyze surgery rates. Results: Mapping of the surgery rates, there was small area variation in anal and/or stomal procedures. The clinic which was located in more competitive market and chose DRG payment system tends to do more anal and/or stomal procedures. There was no factor except DRG bed rates had effect on rate of inguinal and/or femoral hernia procedures. Conclusions: Findings of this study will contribute to developing investigation method on small area variation and policy to reduce the variation such as developing evidence based medical practice guideline.

Keywords

References

  1. 국민건강보험공단. 보도자료 : 건강보험 중복진료실태;2002.
  2. 국민건강보험공단. 국민건강보험 통계연보;2002.
  3. 김윤미. 다빈도 수술의 소규모 지역간 변에에 관한 연구［박사학위 논문］. 서울:서울대학교 대학원;2003.
  4. 김윤미, 고수경, 양봉민(2000). 산부인과의원의 제왕절개율에 영향을 미치는 요인. 보건경제학연구 2000;6(2):51-82.
  5. 문옥륜, 김창엽, 김명기. 동일 진단명에 대한 상병분류기호의 의료기관별 변이에 관한 연구. 보건행정학회지 1992;2(1):66-76.
  6. 박종구, 김기순, 김춘배, 이태용, 이강숙, 이덕희 등. 의료보험청구자료 중 뇌혈관 질환 상병기호의 정확성에 대한 연구. 예방의학회지 2000;33(1):76-82.
  7. 신영전, 이원영, 문옥륜. 의료이용의 지역간 격차 : 3차성 내과계 진단군을 중심으로. 보건행정학회지 1999;9(1):72-109.
  8. 신의철, 박용문, 박용규, 김병성, 박기동, 맹광호. 의료보험자료 상병기호의 정확도 추정 및 관련 특성:법정 전염병을 중심으로. 예방의학회지 1998;31(3):471-480.
  9. 이선희, 조우현, 남정모, 김석일. 일부 다빈도 진단명들의 지역간 의료이용변이. 보건행정학회지 1994;4(1):49-76.
  10. 이홍기, 문옥륜, 이기효. 편도적출술 및 아데노이드 적출술과 충수제거술의 지역별 변이. 예방의학회지 1993;26(3):430-441.
  11. 조우현, 이선희, 박은철, 손명세, 김세라. 지역간 입원이용 변이에 관한 연구. 예방의학회지 1994;27(3):609-626.
  12. 주경식, 김한중, 이선희, 민해영. 도시농촌간 의료이용수준의 비교분석. 예방의학회지 1996; 29(2):311-329.
  13. Ashton CM, Peterson NJ, Souchek J, Menke TJ, Yu HJ, Pietz K. Geographic variations in utilization rates in veterans affairs hospitals and clinics. New England Journal of Medicine 1999; 340(1):32-39. https://doi.org/10.1056/NEJM199901073400106
  14. Broomberg J, Price MR. The impact of the fee for service reimbursement system on the utilization of health services. Part2. Comparision of utilization patterns of medical aid schemes and local health maintenance organization. South Africa Medical Journal 1990;78(3):133-36.
  15. Chassin MR. Explaining geographic variations. Medical Care 1993;31(5):YS37-YS44. https://doi.org/10.1097/00005650-199305001-00006
  16. Clark JD. Variation in Michigan hospital use rates : do physicians and hospitalcharacteristics provide explanations? Soc Sci Med 1990;30(1):67-82. https://doi.org/10.1016/0277-9536(90)90330-U
  17. David MC, Burciaga V, Martin FS, Robert HB. Geographic variation in rates of selected surgical procedure within Los Angeles county. Health Services Research1995;30(1):8-42.
  18. Escarce JJ. Would eliminating differences in physician practice style reduce geographic variations in cataract surgery rates? Medical Care 1993;31(12):1106-18. https://doi.org/10.1097/00005650-199312000-00004
  19. Fisher ES, Wennberg, JE, Stukel TA, Skinner JS, Sharp SM, Freeman JL, Gittelsohn AM. Association among hospital capacity and mortality of U.S. Medicare beneficiaries, controlling for sociodemographic factors. Health Services Research 2000;34(6):1351-1362.
  20. Goodman DC, Green GR. Assessment tools:small area analysis. American Journal of Medical Quality 1996;11(1):S12-4.
  21. Hawker GA, Wright JG, Coyte PC, Willams JI, Harvey B, Glazier R, et al. Determining the need for hip and knee arthroplasty : the role of clinical severity and patients preferences. Medical Care 2001;39(3):206-216. https://doi.org/10.1097/00005650-200103000-00002
  22. Hillman AL, Pauly MV, Kerstein JJ. How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organization? New England Journal of Medicine 1989;321(2):86-92. https://doi.org/10.1056/NEJM198907133210205
  23. Kinstler SB, Pol LG. The marketing implications of migration on hospital and physician supply and demand in the United States. Journal of Hospital Marketing1990;4(1):119-41. https://doi.org/10.1300/J043v04n01_09
  24. McPherson K, Wennberg JE, Hovind OB, Clifford P. Small area variation in the use of common surgical procedures : an international comparison of New England, England and Norway. New England Journal of Medicine 1982;307:1310-1314. https://doi.org/10.1056/NEJM198211183072104
  25. McPherson K et al. Regional variation in the use of common surgical procedires : within and between England and Wales, Canada and United States of America. Soc Sci Med 1981;15A:273-288.
  26. Phelps,CE. The methodological foundations of studies of the appropriateness of medical care. New England Journal of Medicine 1993;329(17)1241-45. https://doi.org/10.1056/NEJM199310213291707
  27. Phelps CE. Diffusion of information in medical care. Journal of Economic Perspectives 1992;6(3):23-42. https://doi.org/10.1257/jep.6.3.23
  28. Phelps CE, Parente ST. Priority setting for medical technology and medical practice assessment. Medical Care 1900;28:8:703-23. https://doi.org/10.1097/00005650-199008000-00004
  29. Wennberg JE. Understanding geographic variations in the health care delivery. New England Journal of Medicine 1993;340(1):52-53. https://doi.org/10.1056/NEJM199901073400111
  30. Wennberg JE, Freeman jL, Shelton RM, Bubolz TA Hospital use and mortality among medicare beneficiaries in Boston and New Haven. New England Journal of Medicine 1989;321(17):1168-73. https://doi.org/10.1056/NEJM198910263211706
  31. Wennberg JE, Mcpherson K, Caper P. Will payment based on diagnosis-related groups control hospital costs? New England Journal of Medicine 1984;311:295-300. https://doi.org/10.1056/NEJM198408023110505
  32. Wennberg JE, Gittelsohn AM. Small area variations in health care delivery. Science 1973;182(117):1102-108. https://doi.org/10.1126/science.182.4117.1102