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The Volume-Outcome Relationship in Japan

The Volume-Outcome Relationship in Japan

The Case of Percutaneous Transluminal Coronary Angioplasty (PTCA) Volume on Mortality of Acute Myocardial Infarction (AMI) Patients

(p.113) 5 The Volume-Outcome Relationship in Japan
Health Care Issues in the United States and Japan
Koichi KawabuchiShigeru Sugihara
University of Chicago Press

This chapter explores the link between the number of percutaneous transluminal coronary angioplasty (PTCA) procedures performed and negative medical outcomes among acute myocardial infarction (AMI) patients in Japan. A physician in a high-volume hospital does not necessarily perform a large number of PTCA procedures. One possibility is that hospital volume has a significant effect on physicians' outcomes. The other possibility is that unobserved common factors affect hospital- and physician-level mortality rates while physician-level mortality is independent of hospital volume. Moreover, it is found that hospital volume does not seem to be an additional contributing factor to the higher quality of health care. The volume effect operates not at the hospital level but at the physician level. Risk adjustment is important for the assessment of the quality of health care. No spillover effects nor organizational skill are observed as represented by hospital volumes.

Keywords:   percutaneous transluminal coronary angioplasty, acute myocardial infarction, hospital volume, health care, physician, risk adjustment

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