Use of healthcare resources in the last six months of life
http://www.100md.com
《英国医生杂志》
EDITOR—Love and Fahey show a fundamental confusion about two distinct questions: whether there is an association between healthcare resources and healthcare use, and why such an association exists.
The validity of the first hypothesis has been understood for many decades in the United States and in countries with central health planning.1 2 Its original incarnation was "Roemer's law": that a hospital bed, once built, tends to be filled. Our contribution is to note the wide variability of use for similar patients, even in high quality hospitals, and even within the same city. Since occupancy rates tend not to vary across hospitals, the only way hospitals can provide more days in intensive care units to their patients is to maintain relatively more intensive care beds.
The second question is whether these variations in utilisation and resources are because of "supplier induced demand," or because of "demand induced demand": differences across regions in health status, preferences, or access to care. Our empirical results are valid under either explanation. Although it is difficult for us to explain our results in light of demand factors (particularly in light of Fisher et al3), readers are free to interpret them as they choose.
We are delighted that Rudolph has noticed our own modest attempt at ironic humour, which is perhaps more familiar to British than American readers. We hope that its use has "increase the effectiveness of a persuasive message."4
Finally, we entirely agree with Bernacki. Network and organisational factors in hospitals are strong contenders in explaining hospital specific variations in the United States.
Jonathan S Skinner, John French professor of economics
Dartmouth College, Hanover, NH 03755, USA Martha.M.Smith@Dartmouth.edu On behalf of the research team
Competing interests: None declared.
References
Feldstein MS. Hospital bed scarcity: an analysis of the effects of inter-regional differences. Economica 1965;32: 393-409.
McPerson K, Wennberg JE, Hovind OB, Clifford P. Small-area variations in the use of common surgical procedures: an international comparison of New England, England and Norway. N Engl J Med 1982;307: 1310-4.
Fisher ES, Wennberg DE, Stukel DA, Gottlieb D, Lucas FL, Pinder E. The implications of regional variations in Medicare spending: Part 2. Health outcomes and satisfaction with care. Ann Intern Med 2003;138: 288-98.
Lyttle J. The effectiveness of humor in persuasion: The case of business ethics training. J Gen Psychol 2001;128: 206-16.
The validity of the first hypothesis has been understood for many decades in the United States and in countries with central health planning.1 2 Its original incarnation was "Roemer's law": that a hospital bed, once built, tends to be filled. Our contribution is to note the wide variability of use for similar patients, even in high quality hospitals, and even within the same city. Since occupancy rates tend not to vary across hospitals, the only way hospitals can provide more days in intensive care units to their patients is to maintain relatively more intensive care beds.
The second question is whether these variations in utilisation and resources are because of "supplier induced demand," or because of "demand induced demand": differences across regions in health status, preferences, or access to care. Our empirical results are valid under either explanation. Although it is difficult for us to explain our results in light of demand factors (particularly in light of Fisher et al3), readers are free to interpret them as they choose.
We are delighted that Rudolph has noticed our own modest attempt at ironic humour, which is perhaps more familiar to British than American readers. We hope that its use has "increase the effectiveness of a persuasive message."4
Finally, we entirely agree with Bernacki. Network and organisational factors in hospitals are strong contenders in explaining hospital specific variations in the United States.
Jonathan S Skinner, John French professor of economics
Dartmouth College, Hanover, NH 03755, USA Martha.M.Smith@Dartmouth.edu On behalf of the research team
Competing interests: None declared.
References
Feldstein MS. Hospital bed scarcity: an analysis of the effects of inter-regional differences. Economica 1965;32: 393-409.
McPerson K, Wennberg JE, Hovind OB, Clifford P. Small-area variations in the use of common surgical procedures: an international comparison of New England, England and Norway. N Engl J Med 1982;307: 1310-4.
Fisher ES, Wennberg DE, Stukel DA, Gottlieb D, Lucas FL, Pinder E. The implications of regional variations in Medicare spending: Part 2. Health outcomes and satisfaction with care. Ann Intern Med 2003;138: 288-98.
Lyttle J. The effectiveness of humor in persuasion: The case of business ethics training. J Gen Psychol 2001;128: 206-16.