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October 25, 2006

Delivering Quality to Patients

Author Affiliations

Author Affiliations: Department of Surgery, Dartmouth Medical School, Hanover, NH; and VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vt.

JAMA. 2006;296(16):2026-2027. doi:10.1001/jama.296.16.2026

In this issue of JAMA, Liu and colleagues1 report that for several surgical procedures, a disproportionately small number of ethnic minorities and poorly insured patients receive care in high-volume hospitals, where quality of care is assumed to be superior. The authors suggest that there is a need for explicit measures to address this disparity. Although intuitively appealing, the authors' observations and suggestions implicitly embrace 2 assumptions that deserve closer scrutiny: (1) ethnic minority and poorly insured patients would want to go to high-volume hospitals if they knew the benefits and could overcome barriers to access, and (2) volume-based referral policies are a good way to improve surgical quality.