RT Journal
A1 Smith M, Wolfe BM
T1 Center of excellence designation: Pros and cons: comment on “reduced access to care resulting from centers of excellence initiatives in bariatric surgery”
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD October 1
VO 145
IS 10
SP 997
OP 998
DO 10.1001/archsurg.2010.217
UL http://dx.doi.org/10.1001/archsurg.2010.217
AB 
Health care accessibility is determined by geographical, financial, cultural, and informational factors. While Livingston and Burchell demonstrate increased median distance traveled, they do not address the time, convenience, or cost of access to care. Financial barriers should not be underestimated, with many bariatric programs forced to limit access to Medicare patients to maintain financial viability. Our own center (Oregon Health & Science University hospital) has restricted access to Medicare patients for this reason. It appears some patients traveled a long distance to Dallas despite the presence of a COE closer to home. The results presented show an increased use of bariatric surgery at UTSW, without demonstrating decreased access overall.