Differences in Use of High-quality and Low-quality Hospitals Among Working-age Individuals by Insurance Type
Differences in Use of High-quality and Low-quality Hospitals Among Working-age Individuals by Insurance Type
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DOI：
10.1097/mlr.0000000000000633
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发表时间：
2017-02-01
期刊：
影响因子：
3
通讯作者：
Escarce, Jose J.
中科院分区：
文献类型：
--
作者：
Popescu, Ioana;Heslin, Kevin C.;Escarce, Jose J.
背景资料：研究表明，有医疗补助或没有保险的人接受的循证治疗较少，并且在各种情况下比有私人保险的人的结果更差。这些差异可能是由于患者在不同quality.Research医院接受护理设计：我们使用医疗保健成本和利用项目国家住院病人数据库2009-2010年的数据，以确定患者年龄18-64岁的私人保险，医疗补助，或没有保险的急性心肌梗死，心力衰竭，肺炎，中风，或胃肠道出血住院。多项logit回归估计的概率入院分类为高，中，低质量的基础上调整的风险，住院mortality.Results：与患者谁有私人保险，那些与医疗补助或没有保险的可能性更大的是少数民族和居住在低社会经济地位的地区。有医疗补助（23.3%）和私人保险（23.0%）的患者入住高质量医院的概率相似，但无保险的患者（19.8%，P < 0.01）显著低于其他两个保险组。人口统计学，社会经济和临床特征的会计没有影响results.Conclusions：以前注意到医疗补助受助人的医院护理质量的差异，他们使用的医院质量的差异不能解释。没有保险的患者对高质量医院的使用率较低，这一发现需要在2013年之后根据《平价医疗法案》进行数据探索，该法案旨在改善没有保险的患者获得医疗服务的机会。
Background: Research suggests that individuals with Medicaid or no insurance receive fewer evidence-based treatments and have worse outcomes than those with private insurance for a broad range of conditions. These differences may be due to patients' receiving care in hospitals of different quality.Research Design: We used the Healthcare Cost and Utilization Project State Inpatient Databases 2009-2010 data to identify patients aged 18-64 years with private insurance, Medicaid, or no insurance who were hospitalized with acute myocardial infarction, heart failure, pneumonia, stroke, or gastrointestinal hemorrhage. Multinomial logit regressions estimated the probability of admissions to hospitals classified as high, medium, or low quality on the basis of risk-adjusted, in-hospital mortality.Results: Compared with patients who have private insurance, those with Medicaid or no insurance were more likely to be minorities and to reside in areas with low-socioeconomic status. The probability of admission to high-quality hospitals was similar for patients with Medicaid (23.3%) and private insurance (23.0%) but was significantly lower for patients without insurance (19.8%, P < 0.01) compared with the other 2 insurance groups. Accounting for demographic, socioeconomic, and clinical characteristics did not influence the results.Conclusions: Previously noted disparities in hospital quality of care for Medicaid recipients are not explained by differences in the quality of hospitals they use. Patients without insurance have lower use of high-quality hospitals, a finding that needs exploration with data after 2013 in light of the Affordable Care Act, which is designed to improve access to medical care for patients without insurance.