Market and regulatory influences on the availability of coronary angioplasty and bypass surgery in U.S. hospitals.

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 less than 0.0001) and 147 percent more likely to offer bypass surgery (P less than 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.

Epidemiology and ethics of coronary artery bypass surgery in an eastern county.

Despite an extensive literature on coronary artery bypass grafting (CABG) surgery in the last decade, relatively little has been written on the demographic or socioeconomic characteristics of patients who receive this limited medical resource. In the present study data were collected on all patients (N = 539) who received this procedure over a one-year period (July 1977 to June 1978) within Erie County in western New York. Using available census tract data, age-sex adjusted surgery rates by socioeconomic status are developed for defined geographic areas. Patients residing in the city of Buffalo and those from census tracts in the lowest quartile of median family income have dramatically lower surgery rates than do others in the county (P less than .001). Although these discrepancies in CABG surgery rates may be partially explained by differing incidence rates of the medical indications for CABG surgery, problems of access to the service may be operative. Three different principles of distributive justice (equality, liberty, and utility) are discussed in an attempt to see how they might be applicable to the pattern documented.

Cardiac surgery in the Federal Republic of Germany during 1978 and 1979. A report by the German Society for Thoracic and Cardiovascular Surgery.

This is a report of the first 2 annual summaries of cardiac surgery performed in 21 units throughout the Federal Republic of Germany during 1978 and 1979. Including hospital mortality rates of the more conventional cardiac procedures, this register demonstrates development in and emphasis on cardiac surgery throughout the country over the years as well as it enables each cardiac surgeon to compare the work of his unit with that of other by giving a nationwide standard.