Policy makers interested in containing health care costs are targeting regional variation in utilization, including the use of advanced imaging.
However, bluntly decreasing utilization among the highest-utilization regions may have negative consequences. In a cross-sectional study of prostate cancer patients from 2004 to 2005, we found that regions with lower rates of inappropriate imaging also had lower rates of appropriate imaging. Similarly, regions with higher overall imaging rates tended to have not only higher rates of inappropriate imaging, but also higher rates of appropriate imaging. In fact, men with high-risk prostate cancer were more likely to receive appropriate imaging if they resided in areas with higher rates of inappropriate imaging. This "thermostat model" of regional health care utilization suggests that poorly designed policies aimed at reducing inappropriate imaging could limit access to appropriate imaging for high-risk patients. Health care organizations need clearly defined quality metrics and supportive systems to encourage appropriate treatment for patients and to ensure that cost containment does not occur at the expense of quality.
Written by:
Makarov DV, Desai R, Yu JB, Sharma R, Abraham N, Albertsen PC, Krumholz HM, Penson DF, Gross CP. Are you the author?
New York University School of Medicine, New York City, USA.
Reference: Health Aff (Millwood). 2012 Apr;31(4):730-40.
doi: 10.1377/hlthaff.2011.033
PubMed Abstract
PMID: 22492890
UroToday.com Prostate Cancer Section