Regionalization of Cardiac Surgery in the United States and Canada

Regionalization of facilities performing cardiac surgery is one of the most contentious regulatory policies currently restricting the supply of specialized health services and technology. This article compares the regionalization policies of the United States (New York and California) and Canada (Ontario, Manitoba, and British Columbia) in terms of geographic access to coronary artery bypass surgery (CABS) and surgical outcomes. Computerized hospital discharge records were used to measure hospital CABS volume and inhospital post-CABS mortality. In both New York and Canada, approximately 60 percent of all CABS operations took place in hospitals performing 500 or more CABS surgeries per year, compared with 25 percent in California. Mortality rates were highest in California hospitals performing fewer than 100 CABS operations per year. The percentage of the population residing within 25 miles of the CABS hospital was 91 percent in California, 82 percent in New York, and less than 60 percent in Canada. Eliminating very low-volume hospitals in California would increase travel distance to a CABS hospital only slightly for a small number of residents. The article concludes that policies of regionalization in New York and Canada have largely enabled these places to avoid the high postoperative mortality rates found in outlier, low-volume California hospitals. There is a great deal to be gained in terms of outcomes and little to lose in terms of access if policies of regionalization, such as those in New York and Canada, are implemented.