Quality of Care in Hospitals with a High Percent of Medicaid Patients

Medicaid beneficiaries often experience worse hospital outcomes than patients with other types of insurance. Though many researchers have attempted to discover the reason for this, none of them have considered hospital quality as a potential cause. The objective of this study is to determine whether hospitals with a high proportion of Medicaid patients provide a different quality of care than other hospitals. Data were used from the Hospital Compare public report and the 2004 American Hospital Association survey. The researchers evaluated the quality of care using 10 performance measures for three common medical conditions—acute myocardial infarction, congestive heart failure and community acquired pneumonia. They then assessed whether the evaluation could be viewed independently from other hospital characteristics such as teaching status, public ownership and location. Those hospitals serving slightly above the national mean percentage of Medicaid patients were designated high Medicaid hospitals. The researchers found in 2,874 nonteaching hospitals considered high Medicaid establishments, health care professionals scored lower on all 10 measures. Of the 889 high Medicaid teaching hospitals, health care professionals performed worse than those in other teaching hospitals for four of 10 processes of care.

Future research should focus on the degree to which patient characteristics impact care and on what effect these differences in adhering to prescribed guidelines may have on clinical outcomes.