In Reply We appreciate Søreide as well as Herb and Stitzenberg’s interest in our study1 that analyzed travel, optimal location, and centralization of hospitals performing pancreatic resection in California. Both letters highlight the concern that centralization can potentially lead to increased disparities among patients seeking care for surgical care. We agree with the authors that this is an important topic and warrants further discussion and consideration. While previous studies2 have suggested a possible added travel burden for certain subgroups of patients, to our knowledge, no study has specifically described what factors may be contributing to an increased burden. In fact, our group noted no differences in race/ethnicity or insurance type among patients who did or did not bypass a high-volume hospital.3,4 As such, certain vulnerable populations (eg, underrepresented minorities and/or low socioeconomic classes) may not have significant geospatial differences to high-volume centers, yet may be susceptible to other types of insurance-based or “narrow network” disparities.5 In addition, disparities may also be driven by other factors, such as knowledge, trust, perceptions of clinicians, and referral patterns.
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Diaz A, Pawlik TM. Regionalization of Pancreatectomy for Pancreatic Cancer—Reply. JAMA Surg. 2020;155(8):787–788. doi:10.1001/jamasurg.2020.0859
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