OBJECTIVES

: The Volume-Outcome Relationship in health economics has been the subject of extensive investigation. To date, most of the studies have found that higher-volume hospitals have better outcomes (e.g., lower mortality rates). These results have shed light on the need to set minimum-volume regulations in order to increase the overall quality of care. In 2018, the French National Health Insurance proposed to increase the minimum-volume threshold for breast cancer from 30 to 150 surgeries per year, and to set a specific threshold for ovarian cancer at 10 cases per year in order to get an authorization to treat these patients. Although increasing minimum-volume thresholds has been shown to improve quality of care, it may also have adverse consequences on patients’ inequalities in access. The aim of this study is to simulate the application of minimum volume threshold for breast cancer and ovarian cancer in France, and explore their impact on socio-economics inequalities.

METHODS

: We modelled patients flows from low to high volume hospitals in terms of probabilities of patients choice of provider based on a revealed preferences framework. We used an exhaustive nationwide administrative dataset (Medical Information Systems Program) of 57726 (4034) patients surgically treated for breast cancer (ovarian cancer) in mainland France in 2018.

RESULTS

: Our results indicate that the application of minimum volume-threshold in France will be very effective to centralize care for breast cancer and ovarian cancer treatment. However, our findings indicate that it will introduce strong inequalities in access to specialized care in terms of travel distance, and will contribute to the medical desertification in rural areas that have already less access to non-specialized care.

CONCLUSIONS

: To devise volume-based policies, policy makers will have to considered its impact on inequalities in access to hospital care in order not to penalize rural areas already suffering from medical desertification.