Volume and outcome--it is time to move ahead.

The volume–outcome hypothesis has created a policymaker's dilemma. In 1979, Luft and colleagues1 reported in the Journal that the number of procedures performed at a hospital (hospital volume) and mortality rates for many surgical procedures were inversely related. Since then, this relation has been documented many times,2 fueling a persistent debate about whether health care should be regionalized and certain sorts of complex, elective care restricted to high-volume medical centers.3–5 Two studies reported in this issue of the Journal will undoubtedly fuel this controversy. In the first, Birkmeyer and colleagues6 used Medicare claims data from 1994 through 1999 to . . .

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