Differences in Use of High-quality and Low-quality Hospitals Among Working-age Individuals by Insurance Type

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. R...

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Bibliographic Details
Published in:Medical care 2017-02, Vol.55 (2), p.148-154
Main Authors: Popescu, Ioana, Heslin, Kevin C., Coffey, Rosanna M., Washington, Raynard E., Barrett, Marguerite L., Karnell, Lucy H., Escarce, José J.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Demographics
Female
Healthcare Disparities - statistics & numerical data
Hospital Administration - statistics & numerical data
Humans
Insurance Coverage - statistics & numerical data
Insurance, Health - statistics & numerical data
Male
Medicaid
Medicaid - statistics & numerical data
Medical treatment
Medically Uninsured - statistics & numerical data
Middle Aged
Mortality
Original Article
Patient admissions
Quality Indicators, Health Care
Quality of Health Care - statistics & numerical data
Socioeconomic Factors
United States
Young Adult
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Summary: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
ISSN:0025-7079
1537-1948
DOI:10.1097/MLR.0000000000000633