Avoidable Hospitalizations And Observation Stays: Shifts In Racial Disparities

Figueroa, José F.; Burke, Laura; Horneffer, Kathryn E; Zheng, Jing; Orav, E. John; Jha, Ashish K.

doi:10.1377/hlthaff.2019.01019

Cited by 22 publications

(33 citation statements)

References 28 publications

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“…Numerous studies have documented racial disparities, including in obstetrical and surgical outcomes, rates of avoidable hospitalizations among seniors, and adherence to guidelines for care of patients with common emergencies such as acute myocardial infarction. 2,[4][5][6][7] While some studies suggest that White and Black patients receive similar quality care within a given hospital, Black patients are more likely to receive care at facilities with lower scores on quality metrics. 2,[8][9][10][11] Moreover, hospitals where Black patients account for a large share of inpatients have relatively modest facilities (as measured by the dollar value of their buildings and equipment), and they are less likely than other hospitals to offer some lucrative higher-tech services like cardiac catheterization labs.…”

Section: Introductionmentioning

confidence: 99%

Hospitals That Serve Many Black Patients Have Lower Revenues and Profits: Structural Racism in Hospital Financing

2022

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Background Care for Black patients is concentrated at a relatively small proportion of all US hospitals. Some previous studies have documented quality deficits at Black-serving hospitals, which may be due to inequities in financial resources for care. Objective To assess disparities in funding between hospitals associated with the proportion of Black patients that they serve. Participants All Medicare-participating hospitals, 2016–2018. Main Measures Patient care revenues and profits per patient day at Black-serving hospitals (the top 10% of hospitals ranked by the share of Black patients among all Medicare inpatients) and at other hospitals, unadjusted and adjusted for differences in case mix and hospital characteristics. Key Results Among the 574 Black-serving hospitals, an average of 43.7% of Medicare inpatients were Black, vs. 5.2% at the 5,166 other hospitals. Black-serving hospitals were slightly larger, and were more often urban, teaching, and for-profit or government (vs. non-profit) owned. Patient care revenues and profits averaged $1,736 and $−17 per patient day respectively at Black-serving hospitals vs. $2,213 and $126 per patient day at other hospitals (p<.001 for both comparisons). Adjusted for patient case mix and hospital characteristics, mean revenues were $283 lower/patient day (p<.001) and mean profits were $111/patient day lower (p<.001) at Black-serving hospitals. Equalizing reimbursement levels would have required $14 billion in additional payments to Black-serving hospitals in 2018, a mean of approximately $26 million per Black-serving hospital. Conclusions US hospital financing effectively assigns a lower dollar value to the care of Black patients. To reduce disparities in care, health financing reforms should eliminate the underpayment of hospitals serving a large share of Black patients.

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Section: Introductionmentioning

confidence: 99%

Hospitals That Serve Many Black Patients Have Lower Revenues and Profits: Structural Racism in Hospital Financing

2022

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“…8,9 They experience higher rates of hospitalization and mortality, as well as higher costs of care. 8,12,13 It is unknown whether there are differences in care quality or access for racial and ethnic minority beneficiaries between the Medicare Advantage and traditional Medicare programs. If there are differences in ambulatory care access and quality, that may have implications for Medicare Advantage vs traditional Medicare enrollment decisions, as well as equity implications for Medicare.…”

mentioning

confidence: 99%

Association of Race and Ethnicity and Medicare Program Type With Ambulatory Care Access and Quality Measures

Johnston

Hammond

Meyers

et al. 2021

JAMA

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IMPORTANCEThere are racial inequities in health care access and quality in the United States. It is unknown whether such differences for racial and ethnic minority beneficiaries differ between Medicare Advantage and traditional Medicare or whether access and quality are better for minority beneficiaries in 1 of the 2 programs. OBJECTIVE To compare differences in rates of enrollment, ambulatory care access, and ambulatory care quality by race and ethnicity in Medicare Advantage vs traditional Medicare. DESIGN, SETTING, AND PARTICIPANTS Exploratory observational cohort study of a nationally representative sample of 45 833 person-years (26 887 persons) in the Medicare Current Beneficiary Survey from 2015 to 2018, comparing differences in program enrollment and measures of access and quality by race and ethnicity. EXPOSURES Minority race and ethnicity (Black, Hispanic, Native American, or Asian/Pacific Islander) vs White or multiracial; Medicare Advantage vs traditional Medicare enrollment. MAIN OUTCOMES AND MEASURESSix patient-reported measures of ambulatory care access (whether a beneficiary had a usual source of care in the past year, had a primary care clinician usual source of care, or had a specialist visit) and quality (influenza vaccination, pneumonia vaccination, and colon cancer screening). RESULTSThe final sample included 6023 persons (mean age, 68.9 [SD, 12.6] years; 57.3% women) from minority groups and 20 864 persons (mean age, 71.9 [SD, 10.8] years; 54.9% women) from White or multiracial groups, who accounted for 9816 and 36 017 person-years, respectively. Comparing Medicare Advantage vs traditional Medicare among minority beneficiaries, those in Medicare Advantage had significantly better rates of access to a primary care clinician usual source of care (79.1% vs 72.5%; adjusted marginal difference, 4.0%; 95% CI, 1.0%-6.9%), influenza vaccinations (67.3% vs 63.0%; adjusted marginal difference, 5.2%; 95% CI, 1.9%-8.5%), pneumonia vaccinations (70.7% vs 64.6%; adjusted marginal difference, 6.1%; 95% CI, 2.7%-9.4%), and colon cancer screenings (69.4% vs 61.1%; adjusted marginal difference, 7.1%; 95% CI, 3.8%-10.3%). Comparing minority vs White or multiracial beneficiaries across both programs, minority beneficiaries had significantly lower rates of access to a primary care clinician usual source of care (adjusted marginal difference, 4.7%; 95% CI, 2.5%-6.8%), specialist visits (adjusted marginal difference, 10.8%; 95% CI, 8.3%-13.3%), influenza vaccinations (adjusted marginal difference, 4.3%; 95% CI, 1.2%-7.4%), and pneumonia vaccinations (adjusted marginal difference, 6.4%; 95% CI, 3.9%-9.0%). The interaction of race and ethnicity with insurance type was not statistically significant for any of the 6 outcome measures. CONCLUSIONS AND RELEVANCEIn this exploratory study of Medicare beneficiaries in 2015-2018, enrollment in Medicare Advantage vs traditional Medicare was significantly associated with better outcomes for access and quality among minority beneficiaries; however, minority beneficiaries were si...

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“…However, the patient is often stuck with a bigger bill and is ineligible for Medicare-paid nursing home care following the hospital stay. 10…”

Section: Health and Inequalitymentioning

confidence: 99%

“…However, the patient is often stuck with a bigger bill and is ineligible for Medicare-paid nursing home care following the hospital stay. 10 Opioid overdose death rates rose faster in counties near shuttered auto plants compared to counties where auto plants remained open, implicating economic distress as a driver of the current opioid crisis. Opioid overdose mortality rates at baseline were similar in both kinds of areas, but 5 years after a plant closure, overdose mortality rates had increased by 8.6/100,000 persons more in plant closure areas, 85% more than the mortality rate in non-closure areas.…”

Section: Health and Inequalitymentioning

confidence: 99%

Health Care Crisis Unabated: A Review of Recent Data on Health Care in the United States

Himmelstein

Woolhandler

2020

Int J Health Serv

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We review recently published studies of U.S. health policy and the nation’s health care system. Even prior to the COVID-19 pandemic, health inequalities were widening and care was inequitably distributed. Although the Affordable Care Act’s coverage expansion improved access to care and timely cancer diagnoses, a large proportion of U.S. residents continued to avoid medical care due to concerns about costs, and access to mental health services remains particularly inadequate. Yet more evidence of private insurers’ profit-driven misbehaviors and of corruption among medical leaders continues to emerge. Misguided incentives and lax regulation encourages nominally nonprofit health care providers to mimic for-profits’ misconduct, and rapacious investors own and control an increasing share of physicians’ practices. Pharmaceutical firms wield outsize political influence and devote far more funds to rewarding investors than to research and development effort. Yet despite vigorous efforts by pharma and other commercial interests to denigrate national health insurance, polls indicate that the COVID-19 pandemic has led to increasing support for such reform.

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Avoidable Hospitalizations And Observation Stays: Shifts In Racial Disparities

Cited by 22 publications

References 28 publications

Hospitals That Serve Many Black Patients Have Lower Revenues and Profits: Structural Racism in Hospital Financing

Hospitals That Serve Many Black Patients Have Lower Revenues and Profits: Structural Racism in Hospital Financing

Association of Race and Ethnicity and Medicare Program Type With Ambulatory Care Access and Quality Measures

Health Care Crisis Unabated: A Review of Recent Data on Health Care in the United States

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