Inequality Set in Concrete: Physical Resources Available for Care at Hospitals Serving People of Color and Other US Hospitals
Inequality Set in Concrete: Physical Resources Available for Care at Hospitals Serving People of Color and Other US Hospitals
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DOI：
10.1177/0020731420937632
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发表时间：
2020-07-01
影响因子：
3.4
通讯作者：
Himmelstein, Kathryn E. W.
中科院分区：
文献类型：
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作者：
Himmelstein, Gracie;Himmelstein, Kathryn E. W.
健康结果方面的种族不平等得到广泛承认。这项研究旨在确定在美国为有色人种服务的医院是否比其他医院拥有更少的实物资产。根据美国4，476家参与医疗保险的医院的数据，我们将黑人和西班牙裔医疗保险住院患者比例的前10%分别定义为“黑人服务”和“西班牙裔服务”。使用2017年医疗保险成本报告和美国医院协会数据，我们比较了这些医院和其他医院的资本资产（土地，建筑物和设备的价值）以及资本密集型服务的可用性，并根据其他医院的特点进行了调整。为有色人种服务的医院的资本资产较低：例如，为黑人服务的医院为5，197美元/患者日（所有美元金额均为美元），为西班牙裔服务的医院为5，763美元，其他医院为8，325美元（两种比较的P < .0001）。2013年至2017年期间，黑人医院、西班牙裔医院和其他医院的新资产购买额分别为1,242美元、1,738美元和3,092美元/患者日（P < .0001）。在调整后的模型中，为有色人种服务的医院的资本资产较低（-215，121美元/床，P < .0001），最近的采购（-83，608美元/床，P < .0001）。它们也不太可能提供27项具体的资本密集型服务中的19项。我们的研究结果表明，为有色人种提供服务的医院的资产比其他医院要少得多，并表明对美国医院设施的平等投资可能会减少护理中的种族不平等。
Racial inequities in health outcomes are widely acknowledged. This study seeks to determine whether hospitals serving people of color in the United States have lesser physical assets than other hospitals. With data on 4,476 Medicare-participating hospitals in the United States, we defined those in the top decile of the share of black and Hispanic Medicare inpatients as "black-serving" and "Hispanic-serving," respectively. Using 2017 Medicare cost reports and American Hospital Association data, we compared the capital assets (value of land, buildings, and equipment), as well as the availability of capital-intensive services at these and other hospitals, adjusted for other hospital characteristics. Hospitals serving people of color had lower capital assets: for example, US$5,197/patient-day (all dollar amounts in U.S. dollars) at black-serving hospitals, $5,763 at Hispanic-serving hospitals, and $8,325 at other hospitals (P < .0001 for both comparisons). New asset purchases between 2013 and 2017 averaged $1,242, $1,738, and $3,092/patient-day at black-serving, Hispanic-serving, and other hospitals, respectively (P < .0001). In adjusted models, hospitals serving people of color had lower capital assets (-$215,121/bed,P < .0001) and recent purchases (-$83,608/bed,P < .0001). They were also less likely to offer 19 of 27 specific capital-intensive services. Our results show that hospitals that serve people of color are substantially poorer in assets than other hospitals and suggest that equalizing investments in hospital facilities in the United States might attenuate racial inequities in care.