紐約州和加拿大安大略省，不同健保制度下PCI使用的差別，代表兩種制度的差異


兩個區域，假設疾病類型相同，由於健保制度之不同
導致 non AMI的人使用percutaneous coronary intervention 量的不同
幾乎差到兩倍
真正AMI的人PCI倒是差不了多少

代表supply boost demand

但是唯有維持這樣的supply，才能撐住emergency PCI的施行(美國比加拿大多得多)
time is muscle, time is life!!
所以，省錢就沒有品質，還是老調


How Do Rates of Cardiac Interventions Compare in New York and Ontario?

A tale of two databases

In this retrospective study, researchers used registry data to compare rates of invasive cardiac procedures in two similarly populated areas with different healthcare reimbursement systems: New York State (NY) and Ontario, Canada. Per capita, NY has about twice as many interventional cardiologists, cardiac surgeons, and hospitals with cardiac invasive facilities as Ontario.

During 2004–2006, the age- and sex-adjusted rate of coronary revascularization was 1.7 times higher in NY than in Ontario, a difference due almost entirely to a higher rate of percutaneous coronary intervention (PCI). The difference was greater in patients without myocardial infarction (MI) than in those with MI. In patients with acute MI, the PCI rate in Ontario increased from 24 per 100,000 residents in 1997–2000 to 65 per 100,000 in 2004–2006; however, even in the latter time period, it remained about 30% lower than in NY (86 per 100,000).

Comment: Assuming that the underlying prevalence of coronary disease is similar in these two geographic areas, these findings suggest that the U.S. healthcare reimbursement system leads to a much greater use of PCI for patients without acute MI, compared with a government-regulated single-payer system. However, the same findings suggest that the U.S. model enables better access to emergency interventions. This study highlights the challenges of weighing potential policy options that limit rising healthcare costs against the need to optimize patient outcomes.

— Howard C. Herrmann, MD

Published in Journal Watch Cardiology August 25, 2010
Citation(s):

Ko DT et al. Temporal trends in the use of percutaneous coronary intervention and coronary artery bypass surgery in New York State and Ontario. Circulation 2010 Jun 22; 121:2635.

* Original article (Subscription may be required)
* Medline abstract (Free)

Ryan TJ. Large cardiac registries: The path to higher quality and lower cost in our healthcare system. Circulation 2010 Jun 22; 121:2612.

* Original article (Subscription may be required)
* Medline abstract (Free)

https://docs.google.com/fileview?id=0B278nGJMQBk7ODhkMjg2MTEtMGNmZC00NDhhLTgxMGEtYjk3MzVjNzYyMDQ3&hl=zh_TW

https://docs.google.com/fileview?id=0B278nGJMQBk7Y2VmYmQ5OWEtMWYzZS00ZWQzLWJiOGQtOWU4NjViYzUyZDlh&hl=zh_TW

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TG無用論，不用吃fenofibrate了，除非> 500mg/dl

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