Health care disparities are commonly analyzed along lines of socioeconomic status, age, geography, and race; however, a new study, published in Health Affairs, concludes that the quality of care within any given hospital varies based on patients' insurance. Specifically, the study revealed that "Medicare patients appeared particularly vulnerable to receiving inferior care."
Using inpatient data from hospitals in 11 states, the researchers compared risk-adjusted mortality rates within hospitals for patients according to their insurance status. The researchers found that "privately insured patients had lower risk-adjusted mortality rates than Medicare enrollees for twelve out of fifteen quality measures examined." As reported in FierceHealthcare, the difference in quality was significant. Mortality rates for Medicare patients were over 100% higher for hip replacement and esophageal resection procedures. Overall, Medicare patients averaged 5.85 more deaths per 1,000 patients compared to privately insured patients in the same hospital. Privately insured patients also had lower risk-adjusted mortality rates compared to patients in other payer groups, although the difference in quality was less significant.
FierceHealthcare notes that the researchers hypothesized the disparity in quality was due, in part, to "delays or restrictions in care and unequal access to newer technology. Privately insured patients also may have doctors who provide them with more individualized treatment, or have access to 'newer, more expensive treatments.'" In the study abstract, the researchers conclude "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."
The results of this study reinforce general conclusions made by the Agency for Healthcare Research and Quality (AHRQ). In the 2012 National Health Disparities Report, the authors note that AHRQ previously concluded that "health insurance [is] the most significant contributing factor to poor quality of care in some of the core measures of quality," and those with no insurance and public insurance are more likely than those with private insurance to face challenges getting needed medical care.
As previously reported in Policy and Medicine, hospitals are at the forefront of the Obama Administration's efforts to improve quality and care coordination. With new quality reporting measures in the pipeline, implicating key elements of the Affordable Care Act's hospital value-based purchasing and hospital readmissions reduction programs, this study reveals that quality improvement within individual hospitals is tied to consistency in treatment practices across patient insurance groups.