Specialty hospitals have been plagued by accusations that they select patients from a pool of wealthier, better-insured people, leaving general hospitals with higher-risk and less-insured patients. Most previous studies on this topic, however, have had methodological shortcomings that weakened their results.
This retrospective study of 41,863 patients with a variety of cardiac conditions admitted to specialty cardiac and general hospitals examined transfer patterns of patients with less coverage, as well as proportions of all patients admitted to both types of hospitals with more generous insurance coverage. The study used all-payer State Inpatient Data (SID) from California, Texas, and Arizona, collected between 2000–2003.
- Patients admitted to specialty hospitals were older, less likely to be female, black or Hispanic, and had lower rates of comorbidities such as diabetes.
- Specialty hospitals admitted a smaller proportion of patients from the ER and a higher proportion of patients as transfers from other acute-care hospitals than did general hospitals.
- Patients at specialty hospitals were more likely to have Medicare, but no more likely to have private insurance, than patients admitted to general hospitals. Also, patients were less likely to have Medicaid or self-paid insurance plans.
- After adjusting for proximity to hospitals, comorbidities, patient demographics, and other factors, patients with more generous insurance were 20 percent more likely to be admitted to specialty hospitals than similar patients with less generous insurance.
- Rates of transfer for both were similar within insurance categories.
This study expanded on previous studies in several ways: It is one of few studies to account for geographic proximity by demographics of patient populations and for comorbidities of patients. After accounting for these variables, the study finds that specialty hospitals are admitting smaller proportions of patients with less generous care; however, the authors were unable to determine whether patients, providers or both were driving the observed disparities. Limitations of this study include the small sample size of patients admitted and transferred to specialty hospitals with less generous insurance, and the fact that most cardiac procedures are covered by Medicare, and thus the proportion of underinsured cardiac patients is low.