More Minority Patients in Low-Quality, High-Cost Hospitals

More elderly black, Hispanic, Medicaid patients consult worst rather than best hospitals

THURSDAY, Oct. 6 (HealthDay News) -- Hospitals where the quality is low and costs high (worst hospitals) in the United States care for a higher proportion of elderly black, Hispanic, and Medicaid patients than high-quality, low-cost institutions (best hospitals), according to a study published in the October issue of Health Affairs.

Ashish K. Jha, M.D., M.P.H., from the Harvard School of Public Health in Boston, and colleagues examined the impact of U.S. national programs aimed at managing quality and costs of health care on minority and poor patients, and the hospitals that provide most of their care. Hospital data were analyzed, and hospitals were assigned to various categories, including 178 hospitals which were categorized as the "best" and 122 as the "worst."

The investigators found that the worst hospitals were typically in the South (small public or for-profit institutions) and cared for double the proportion of elderly black patients as the best hospitals, which were mainly nonprofit institutions in the Northeast (15 versus 7 percent). Elderly Hispanic and Medicaid patients constituted 1 and 15 percent, respectively, of the patient population at the best hospitals, and 4 and 23 percent, respectively, at the worst hospitals. Compared to patients with acute myocardial infarction admitted to the best hospitals, those admitted at the worst hospitals had 7 to 10 percent higher odds of death.

"The institutions that perform worse on both quality and cost metrics care for greater numbers of elderly black and Medicaid patients," the authors write. "We will need to help hospitals improve quality and efficiency simultaneously and to monitor the results of their efforts."

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