Understanding Disparities in Surgical Outcomes for Medicaid Beneficiaries

Background Few studies have evaluated whether outcome disparities between Medicaid and private insurance beneficiaries are driven by the hospital at which the patient receives care. The purpose of this study was to evaluate the effect of the hospital on surgical outcomes in Medicaid beneficiaries. M...

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Bibliographic Details
Published in:World journal of surgery 2019-04, Vol.43 (4), p.981-987
Main Authors: Claflin, Jake, Dimick, Justin B., Campbell, Darrell A., Englesbe, Michael J., Sheetz, Kyle H.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adult
Cardiac Surgery
Complications
Diagnosis-Related Groups
Discharge
Emergency medical services
Emergency Service, Hospital - statistics & numerical data
Female
General Surgery
Geriatrics
Government programs
Health care
Healthcare Disparities
Humans
Insurance
Insurance, Health
Logistic Models
Male
Medicaid
Medicine
Medicine & Public Health
Michigan
Middle Aged
Older people
Original Scientific Report
Patient Acceptance of Health Care - statistics & numerical data
Patient Readmission - statistics & numerical data
Population studies
Postoperative Complications - epidemiology
Registries
Resource utilization
Risk Adjustment
Subacute care
Surgery
Surgical outcomes
Surgical Procedures, Operative
Thoracic Surgery
Treatment Outcome
United States
Vascular Surgery
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Summary:Background Few studies have evaluated whether outcome disparities between Medicaid and private insurance beneficiaries are driven by the hospital at which the patient receives care. The purpose of this study was to evaluate the effect of the hospital on surgical outcomes in Medicaid beneficiaries. Methods We identified 139,566 non-elderly Medicaid and private insurance beneficiaries undergoing general, vascular, or gynecological surgery between 2012 and 2017 using a statewide clinical registry in Michigan. We calculated risk-adjusted rates of complications, readmissions, emergency department (ED) visits, and post-acute care utilization using multivariable logistic regression, accounting for patient and procedural factors. We then evaluated whether, and to what extent, the hospital influenced outcome disparities between Medicaid and privately insured beneficiaries. Results Risk-adjusted rates for all outcomes were higher in Medicaid beneficiaries. For example, overall post-discharge ED visit rates were 14.3% (95% CI 13.7% to 14.9%) for Medicaid compared to 7.5% (95% CI 7.1% to 7.9%, P  
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-018-04891-y