The Effects of Safety Net Hospital Closures and Conversions on Patient Travel Distance to Hospital Services
The Effects of Safety Net Hospital Closures and Conversions on Patient Travel Distance to Hospital Services
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DOI：
10.1111/j.1475-6773.2011.01318.x
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发表时间：
2012-02-01
影响因子：
3.4
通讯作者：
Mobley, Lee Rivers
中科院分区：
文献类型：
--
作者：
Bazzoli, Gloria J.;Lee, Woolton;Mobley, Lee Rivers
目标。检查安全网医院（SNH）关闭和营利性转换对无保险、医疗补助和种族/少数民族的影响。数据源/提取方法。选定州的出院数据与其他来源合并。研究设计。我们对在城市医院就诊的患者的出行距离进行了五类诊断：门诊敏感病症、转诊敏感病症、标记病症、出生、精神健康和药物滥用。我们评估了SNH事件后旅行对患者的影响。我们的多变量模型控制了患者、医院、卫生系统和社区特征。主要的发现。我们的研究结果表明，某些群体的无保险和医疗补助患者在护理模式上经历了更大的破坏，特别是西班牙裔无保险和医疗补助住院分娩的妇女。此外，相对于SNH事件社区中有私人保险的个人，没有保险的人前往精神健康和药物滥用治疗的次数更多。由于潜在的权力问题，我们的结果有些不确定，但snh的关闭或营利性转换似乎对弱势群体的特定亚群具有不利的获取影响。政策制定者可能需要特别关注这些患者亚群，并在处理SNH资源减少造成的中断时减轻运输障碍。
Objective. To examine the effects of safety net hospital (SNH) closure and for-profit conversion on uninsured, Medicaid, and racial/ethnic minorities.Data Sources/Extraction Methods. Hospital discharge data for selected states merged with other sources.Study Design. We examined travel distance for patients treated in urban hospitals for five diagnosis categories: ambulatory care sensitive conditions, referral sensitive conditions, marker conditions, births, and mental health and substance abuse. We assess how travel was affected for patients after SNH events. Our multivariate models controlled for patient, hospital, health system, and neighborhood characteristics.Principal Findings. Our results suggested that certain groups of uninsured and Medicaid patients experienced greater disruption in patterns of care, especially Hispanic uninsured and Medicaid women hospitalized for births. In addition, relative to privately insured individuals in SNH event communities, greater travel for mental health and substance abuse care was present for the uninsured.Conclusions. Closure or for-profit conversions of SNHs appear to have detrimental access effects on particular subgroups of disadvantaged populations, although our results are somewhat inconclusive due to potential power issues. Policy makers may need to pay special attention to these patient subgroups and also to easing transportation barriers when dealing with disruptions resulting from reductions in SNH resources.