M. Hurley4, L. Schoemaker2, J. Morton1, S. Wren1, S. Watanabe3, A. Yoshikawa3, J. Bhattacharya2 1Stanford University,Department Of Surgery,Palo Alto, CA, USA 2Stanford University,Center For Health Policy/Center For Primary Care And Outcomes Research,Palo Alto, CA, USA 3Global Health Consulting Japan,Tokyo, TOKYO, Japan 4Stanford University,Health Research And Policy,Palo Alto, CA, USA
Introduction: Unwarranted geographic variation in spending has received intense scrutiny in the US. However, few studies have compared variation in spending and outcomes between different healthcare systems. In this study, we compare the geographic variation in post-surgical outcomes and cost of hospitalization between the United States and Japan.
Methods: This retrospective study uses Medicare Part A data from the United States (2010-2011) and similar inpatient data from Japan (2012). Patients above the age of 65 undergoing one of five surgeries (CABG, AAA repair, colectomy, pancreatectomy, gastrectomy) were selected in the US and Japan. The weighted age- and sex-standardized coefficient of variation (COV) was calculated for post-operative mortality, the development of a complication, death after complication, length of stay, and the cost of the hospitalization. An adjusted COV was also calculated for each measure, additionally controlling for patient demographics, comorbidities, and urgency of admission.
Results: With the exception of length of stay after colectomy, the variability of the four post-surgical outcomes for all five surgeries was uniformly lower in the US compared to Japan. This pattern held even after adjusting for patient comorbidities. In contrast, cost variation was consistently higher in the US for all surgeries compared to Japan. The level of cost variation between surgeries was similar in the US (adjusted COV values of 17 to 22) and also in Japan (adjusted COV values of 5 to 11), indicating that within each country, the specific type of surgery had minimal influence on overall cost variability.
Conclusion: Though the US healthcare system has higher cost inefficiency, the presence of higher geographic variation in post-operative outcomes in Japan relative to the US suggests that the observed geographic variation in the US, both for health expenditures and outcomes, is not a unique manifestation of its structural shortcomings.
