Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 8
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Kim, Woohyeon Wolff, Stephen and Ho, Vivian 2016. Measuring the Volume-Outcome Relation for Complex Hospital Surgery. Applied Health Economics and Health Policy, Vol. 14, Issue. 4, p. 453.

    Hentschker, Corinna and Mennicken, Roman 2015. The Volume-Outcome Relationship and Minimum Volume Standards - Empirical Evidence for Germany. Health Economics, Vol. 24, Issue. 6, p. 644.

    Brand, Keith Gaynor, Martin McAlvanah, Patrick Schmidt, David and Schneirov, Elizabeth 2014. Economics at the FTC: Office Supply Retailers Redux, Healthcare Quality Efficiencies Analysis, and Litigation of an Alleged Get-Rich-Quick Scheme. Review of Industrial Organization, Vol. 45, Issue. 4, p. 325.

    Ravi, Praful Bianchi, Marco Hansen, Jens Trinh, Quoc-Dien Tian, Zhe Meskawi, Malek Abdollah, Firas Briganti, Alberto Shariat, Shahrokh F. Perrotte, Paul Montorsi, Francesco Karakiewicz, Pierre I. and Sun, Maxine 2014. Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis. BJU International, Vol. 113, Issue. 5, p. 733.

    Ikkersheim, David Tanke, Marit van Schooten, Gwendy de Bresser, Niels and Fleuren, Hein 2013. Modeling hospital infrastructure by optimizing quality, accessibility and efficiency via a mixed integer programming model. BMC Health Services Research, Vol. 13, Issue. 1,

    Blankart, Carl Rudolf 2012. Does healthcare infrastructure have an impact on delay in diagnosis and survival?. Health Policy, Vol. 105, Issue. 2-3, p. 128.

    Harbrecht, Brian G. Smith, Jason W. Franklin, Glen A. Miller, Frank B. and Richardson, J. David 2010. Decreasing Regional Neurosurgical Workforce—A Blueprint for Disaster. The Journal of Trauma: Injury, Infection, and Critical Care, Vol. 68, Issue. 6, p. 1367.

    Ho, Vivian and Aloia, Thomas 2008. Hospital Volume, Surgeon Volume, and Patient Costs for Cancer Surgery. Medical Care, Vol. 46, Issue. 7, p. 718.


Regionalization versus competition in complex cancer surgery

  • Vivian Ho (a1), Robert J. Town (a2) and Martin J. Heslin (a3)
  • DOI:
  • Published online: 01 January 2007

The empirical association between high hospital procedure volume and lower mortality rates has led to recommendations for the regionalization of complex surgical procedures. While regionalization may improve outcomes, it also reduces market competition, which has been found to lower prices and improve health care quality. This study estimates the potential net benefits of regionalizing the Whipple surgery for pancreatic cancer patients. We confirm that increased hospital volume and surgeon volume are associated with lower inpatient mortality rates. We then predict the price and outcome consequences of concentrating Whipple surgery at hospitals that perform at least two, four, and six procedures respectively per year. Our consumer surplus calculations suggest that regionalization can increase consumer surplus, but potential price increases extract over half of the value of reduced deaths from regionalization. We reach three conclusions. First, regionalization can increase consumer surplus, but the benefits may be substantially less than implied by examining only the outcome side of the equation. Second, modest changes in outcomes due to regionalization may lead to decreases in consumer surplus. Third, before any regionalization policy is implemented, a deep and precise understanding of the nature of both outcome/volume and price/competition relationships is needed.

Corresponding author
Corresponding author: Dr Vivian Ho, Baker Institute for Public Policy - MS 40, Rice University, 6100 Main Street, Houston, TX 77005, USA. Tel: +1 (713) 348-2195; Fax: +1 (713) 348-5278; Email:
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
Please enter your name
Please enter a valid email address
Who would you like to send this to? *