Low-Quality, High-Cost Hospitals, Mainly In South, Care For Sharply Higher Shares Of Elderly Black, Hispanic, And Medicaid Patients
Low-Quality, High-Cost Hospitals, Mainly In South, Care For Sharply Higher Shares Of Elderly Black, Hispanic, And Medicaid Patients
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DOI：
10.1377/hlthaff.2011.0027
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发表时间：
2011-10-01
期刊：
影响因子：
9.7
通讯作者：
Epstein, Arnold M.
中科院分区：
文献类型：
--
作者：
Jha, Ashish K.;Orav, E. John;Epstein, Arnold M.
当政策制定者设计旨在管理医疗质量和成本的国家计划时，重要的是要了解对少数民族和贫困患者以及提供大部分医疗服务的医院的潜在影响。我们分析了一系列的医院数据，并将医院分为不同的类别，包括“最好的”--高质量、低成本的机构和“最差的”--质量低、成本高。我们发现，“最差”的医院-通常是南方的小型公立或营利性机构-照顾老年黑人患者的比例是“最好”医院的两倍（15%对7%）-通常是东北部的非营利机构。同样，西班牙裔和医疗补助老年患者分别占最好医院患者人数的1%和15%，而在最差医院，这些群体分别占患者人数的4%和23%。在最差医院的急性心肌梗死患者的死亡率比在最好医院的患者高7- 10%。我们的研究结果对医疗保险即将推出的基于价值的购买计划具有重要意义。特别是最差的机构必须在成本和质量上都有所改善，以避免招致经济处罚和加剧护理方面的差距。
As policy makers design national programs aimed at managing the quality and costs of health care, it is important to understand the potential impact on minority and poor patients and the hospitals that provide most of their care. We analyzed a range of hospital data and assigned hospitals to various categories, including "best"-high-quality, low-cost institutions-and "worst"-where quality is low and costs high. We found that the "worst" hospitals-typically small public or for-profit institutions in the South-care for double the proportion (15 percent versus 7 percent) of elderly black patients as the "best" hospitals-typically nonprofit institutions in the Northeast. Similarly, elderly Hispanic and Medicaid patients accounted for 1 percent and 15 percent, respectively, of the patient population at the best hospitals, while at the worst hospitals, these groups represented 4 percent and 23 percent of the patients. Patients with acute myocardial infarction at the worst hospitals had 7-10 percent higher odds of death compared to patients with those conditions admitted to the best hospitals. Our findings have important implications for Medicare's forthcoming value-based purchasing program. The worst institutions in particular will have to improve on both costs and quality to avoid incurring financial penalties and exacerbating disparities in care.