In attempting to explain why hospitals vary in the quality of care delivered to patients, a considerable body of health policy research points to differences in hospital characteristics such as ownership, safetynet status, and geographic location as the most important contributing factors. This article examines the extent to which a patient's type or lack of insurance may also play a role in determining the quality of care received at any given hospital. We compared within-hospital quality, as measured by risk-adjusted mortality rates, for patients according to their insurance status. We examined the Agency for Healthcare Research and Quality's innovative Inpatient Quality Indicators and pooled 2006-08 State Inpatient Database records from eleven states. We found that privately insured patients had lower risk-adjusted mortality rates than did Medicare enrollees for twelve out of fifteen quality measures examined. To a lesser extent, privately insured patients also had lower risk-adjusted mortality rates than those in other payer groups. Medicare patients appeared particularly vulnerable to receiving inferior care. These findings suggest that to help reduce care disparities, public payers and hospitals should measure care quality for different insurance groups and monitor differences in treatment practices within hospitals.

Using three years of state inpatient discharge data from thirteen states, we computed, for each hospital, race/ethnicity-specific quality measures using the Agency for Healthcare Research and Quality inpatient quality indicators and patient safety indicators. We found that risk-adjusted quality indicators for blacks, Hispanics, and Asians were not statistically worse than corresponding quality indicators for whites in the same hospital. We conclude that when whites and minorities are admitted to the hospital for the same reason or receive the same hospital procedure, they receive the same quality of care. Only a few hospitals provide lower quality of care to minorities than to whites.

The results suggest that access to care for individuals with blindness and vision impairment is problematic, for reasons that are amenable to policy interventions.

Employing three years of inpatient discharge data from 11 states and inpatient and patient safety quality indicators from the Agency for Healthcare Research and Quality (AHRQ), this paper explored whether minority (black, Hispanic, and Asian) patients used lower quality hospitals. We found that the association between the share of minority patients and hospital quality depended on how quality was measured and varied by race and ethnicity. Hospitals serving Hispanics performed well on most patient safety measures. Higher percentages of all three minority patient groups corresponded to lower quality for only one measure, postoperative sepsis. Our analysis indicates that it is incorrect to generalize that minorities use lower quality hospitals. Analysts and policymakers should be cautious when making generalizations about the overall service quality of hospitals that treat minority patients.

Uncompensated care pools have been used by several states in their attempt to aid hospitals and increase the volume of care provided to patients without health insurance. We examined the uncompensated care pool used in New York State between 1983 and 1987. Our primary interest was to estimate the impact of the pools on the level and type of care provided to uninsured patients. Our results indicate that hospitals responded to the pools by increasing the volume of care provided to uninsured patients. Without the pools, over 30,000 fewer adjusted hospital admissions would have been provided to the uninsured in a typical year. Many of these newly purchased admissions were for "nondiscretionary" medical care, suggesting that beneficial care to the indigent was rationed prior to the introduction of the uncompensated care pools.