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Study: Essential Hospitals Remain Essential after Reform

Hospitals that care for the vulnerable and provide vital services to all remain essential to their communities following health care reform efforts, according to a new study led by Boston Medical Center researchers.

For the study, researchers compared all-payer inpatient discharge data from three states — Massachusetts, New York, and New Jersey — for the 21 months preceding health care reform in Massachusetts (October 2004 to June 2006) with data for the 21 months following the reforms (January 2008 to September 2009). The efforts in Massachusetts were used as a model for the Affordable Care Act (ACA).

Researchers defined minority-serving hospitals as the 20 percent of facilities with the highest proportion of minority patients discharged. They found that following the reforms in Massachusetts, the percentage of minority discharges in minority-serving hospitals increased by 5.8 percent in that state compared with New Jersey and 2.1 percent compared with New York.

Researchers also examined safety-net hospitals, which they defined as those in the highest quartile for patients with Medicaid coverage or who were “self-pay,” “indigent,” or “hospital responsibility.” Among the three states examined, 62 percent of “safety-net hospital users” — patients with two or more hospitalizations before the Massachusetts reforms and with two or more hospitalizations after the reforms began — continued to use safety-net hospitals after the start of reforms.

Overall, the researchers found “that minorities did not, by and large, move from safety-net to nonsafety-net hospitals” and that “the racial/ethnic patient mix at hospitals has not, as yet, changed substantively” in Massachusetts following the state’s health care reforms. These findings suggest “that the same may occur nationwide, with ACA implementation,” and underscore “the importance of continued support for safety-net and minority-serving hospitals as national reform unfolds,” according to the study.

The authors noted that patient loyalty to certain hospitals and the potential that “safety-net hospital users” were substantially sicker than other patients, among other factors, could have affected the findings.

But the results still could inform how national health insurance coverage expansions might affect safety-net and minority-serving hospitals. The study concluded, “If, as we and others have observed, patients continue to receive care in safety-net settings, yet disproportionate share funds for the safety-net are cut and reimbursement rates from the public forms of insurance people received under the reform are lower than the cost of care, the safety-net could be financially undermined.”

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About the Author

Michelle Rosenfeld is senior writer/editor at America's Essential Hospitals.

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