Clement JP, Chukmaitov A; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1599.
Virginia Commonwealth University, Department of Health Administration, P.O. Box 980203, 1008 E. Clay Street, Richmond, VA 23298-0203 Tel. 804 828-1886 Fax 804 828-1894
RESEARCH OBJECTIVE: Although researchers have examined disparities in access to care for population groups, there is less research on potential disparities in hospital care delivered. This study assesses whether there are disparities in the quality of hospital care received by Medicaid and self-pay patients compared to patients covered by more generous private insurance plans and whether any differences have become more or less pronounced over time. STUDY DESIGN: Rates for AHRQ inpatient quality and patient safety indicators (IQIs and PSIs) are determined for hospitals for each year from 1995 through 2000. The measures are risk adjusted for the patients age, gender and APR-DRG and smoothed to eliminate random variation in rates. We use multiple measures, choosing the measures where a large number of patients would be at risk of the adverse outcome. Thus, we selected five IQIs because a large share of US hospitals treat a sufficient number of patients with diagnoses relevant to the IQI. However, because PSIs are not condition specific, we selected the eight PSIs that involve the largest number of patients who are at risk of adverse outcomes. POPULATION STUDIED: All short term general medical-surgical (or acute care) hospitals from 11 states (AZ, CA, CO, FL, IA, MD, MA, NJ, NY, WA, and WI) that participated in the AHRQs HCUP State Inpatient Databases (SID) program. PRINCIPAL FINDINGS: Preliminary findings suggest that relative to private pay hospital mortality rates (IQIs), rates for Medicaid and self pay patients are significantly higher in 1995 and 1998 even though the average Medicaid case-mix is lower than the average private pay case-mix. The average self-pay case mix is similar to the private pay case-mix. In 2000, the findings are somewhat different. Only one hospital Medicaid IQI rate is significantly higher than the hospital private pay rate. Three of the five hospital self pay IQI rates are still significantly higher than the private pay rates. In contrast, for seven of the eight hospital patient safety indicator rates (PSIs) both the hospital Medicaid and self-pay rates are consistently significantly higher than the private pay rates in 1995, 1998 and 2000. Over time, self pay and private pay IQI and PSI rates have consistently increased while those for Medicaid have either increased or decreased. CONCLUSIONS: Mortality and patient safety rates differ by payer and to have changed at different rates over time. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Although preliminary findings indicate Medicaid and self-pay patients have worse outcomes on average than private pay patients, there appear to be improvements in some of the hospital mortality rates over time but not in the patient safety indicators. In addition to seeking to eliminate disparities in access to care, researchers and policy-makers need to examine differences in the underlying processes of hospital care for disadvantaged populations.
Publication Types:
Keywords:
- Diagnosis-Related Groups
- Hospital Mortality
- Hospitalization
- Hospitals, Private
- Humans
- Inpatients
- Insurance, Hospitalization
- Medicaid
- Safety
- United States Agency for Healthcare Research and Quality
- economics
- hsrmtgs
UI: 103624633
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