The impact of payer status on hospital admissions: evidence from an academic medical center.
The impact of payer status on hospital admissions: evidence from an academic medical center.
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DOI：
10.1186/s12913-021-06886-3
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发表时间：
2021-09-07
影响因子：
2.8
通讯作者：
Hu J
中科院分区：
文献类型：
--
作者：
Zhao Y;Paschalidis IC;Hu J
有大量的研究调查支付地位的差距在获得护理。然而，大多数研究要么是针对特定疾病，要么是针对特定人群。通过大型对照研究量化设施水平的差异是罕见的。本研究旨在从医疗机构的角度，探讨付款人身份如何影响病人住院治疗。我们提取了某医疗中心2009年5月1日至2014年4月30日期间的所有就诊记录，然后将目标入院时间前三年的门诊和住院记录与患者联系起来。我们使用条件逻辑回归方法进行回顾性观察研究。为了在训练模型时控制不同疾病患者的病情，我们利用数据分层技术构造了一个三维变量。该模型在不同于用于训练的数据集上进行验证。私人保险承保的患者或没有保险的患者住院的可能性低于政府保险承保的患者。对于没有保险的病人，观察到在获得住院治疗方面的不平等。标准化系数的值表明，政府资助的保险对改善患者住院的影响最大。需要注意改善没有保险的病人获得护理的机会。同时，应加强基本预防保健服务，特别是针对政府参保人员。研究结果可作为衡量减少住院支付者地位差异的措施的预期效果的基线。在线版本包含补充材料，可在（10.1186/s12913-021-06886-3）获得。
There are plenty of studies investigating the disparity of payer status in accessing to care. However, most studies are either disease-specific or cohort-specific. Quantifying the disparity from the level of facility through a large controlled study are rare. This study aims to examine how the payer status affects patient hospitalization from the perspective of a facility. We extracted all patients with visiting record in a medical center between 5/1/2009-4/30/2014, and then linked the outpatient and inpatient records three year before target admission time to patients. We conduct a retrospective observational study using a conditional logistic regression methodology. To control the illness of patients with different diseases in training the model, we construct a three-dimension variable with data stratification technology. The model is validated on a dataset distinct from the one used for training. Patients covered by private insurance or uninsured are less likely to be hospitalized than patients insured by government. For uninsured patients, inequity in access to hospitalization is observed. The value of standardized coefficients indicates that government-sponsored insurance has the greatest impact on improving patients’ hospitalization. Attention is needed on improving the access to care for uninsured patients. Also, basic preventive care services should be enhanced, especially for people insured by government. The findings can serve as a baseline from which to measure the anticipated effect of measures to reduce disparity of payer status in hospitalization. The online version contains supplementary material available at (10.1186/s12913-021-06886-3).
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