The article “Disparities in the Utilization of High-Volume Hospitals for Complex Surgery” by authors Liu and colleagues is an important contribution to the literature by surgeons from the University of California in Los Angeles concerning the access to surgical care in the state of California. Databases such as California's Office of Statewide Health Planning and Development are essential for us as surgeons to evaluate trends in surgical care that do not necessarily reflect our own practice. This study reveals that there are substantial disparities for certain ethnic groups and those with Medicaid and/or no insurance in receiving care at a high-volume hospital. The type of procedure has impact as well. All the reasons for these disparities are unknown but need to be investigated. I once visited a midsized midwestern town to give grand rounds and was told that the patients chose 1 of the 2 main hospitals in the city depending on which side of a river (that ran through the middle of the city) they lived on. People living on the east side went to one hospital, and people living on the west side went to the other. The river determined their choice of health care providers.
Freischlag JA. Crossing the River. Arch Surg. 2007;142(2):112. doi:10.1001/archsurg.142.2.112