In this issue of JAMA, Liu and colleagues1 report that for several surgical procedures, a disproportionately small number of ethnic minorities and poorly insured patients receive care in high-volume hospitals, where quality of care is assumed to be superior. The authors suggest that there is a need for explicit measures to address this disparity. Although intuitively appealing, the authors' observations and suggestions implicitly embrace 2 assumptions that deserve closer scrutiny: (1) ethnic minority and poorly insured patients would want to go to high-volume hospitals if they knew the benefits and could overcome barriers to access, and (2) volume-based referral policies are a good way to improve surgical quality.
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