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Vallejo MC, Shapiro RE, Lilly CL, Nield LS, Ferrari ND. The influence of medical insurance on obstetrical care. J Healthc Risk Manag 2021; 41:16-21. [PMID: 33094546 PMCID: PMC8060349 DOI: 10.1002/jhrm.21451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Maternal and obstetrical outcomes vary widely within the United States. The impact of insurance type on health care disparities and its influence on obstetrical care and maternal outcome is not clear. We report the impact of health care insurance on obstetrical and maternal outcomes in a tertiary care health care system. Our maternal quality care database (n = 4199) was queried comparing commercial insurance to government sponsored insurance from July 1, 2015 through June 30, 2018. Parturients with commercial insurance were older, weighed more, presented with less gravidity and parity, had more advanced gestation, and had a higher neonatal 5-minute Apgar score than government insured parturients. Additionally, government insured parturients were less likely to be admitted for induction with oxytocin, receive labor epidural analgesia, and have a primary caesarean delivery. Similarly, government insured parturients were more likely to be of African American descent, be a current known smoker, have a positive urine drug screen, and receive a general anesthetic. We conclude obstetrical and maternal health care disparities exist based on medical insurance type.
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Affiliation(s)
- Manuel C Vallejo
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, West Virginia
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Robert E Shapiro
- Department of Obstetrics & Gynecology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Christa L Lilly
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia
| | - Linda S Nield
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, West Virginia
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Norman D Ferrari
- Department of Medical Education, West Virginia University School of Medicine, Morgantown, West Virginia
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
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Kupsky DF, Wang DD, Eng M, Gheewala N, Nakhle A, Georgie F, Shah R, Wyman J, Mahan M, Greenbaum A, O’Neill WW. Socioeconomic Disparities in Access for Watchman Device Insertion in Patients with Atrial Fibrillation and at Elevated Risk of Bleeding. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1569795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Daniel F. Kupsky
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Dee Dee Wang
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Marvin Eng
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Neil Gheewala
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Asaad Nakhle
- Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Fawaz Georgie
- Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Rajan Shah
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Janet Wyman
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Meredith Mahan
- Department of Biostatistics, Henry Ford Health System, Detroit, Michigan, USA
| | - Adam Greenbaum
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
| | - William W. O’Neill
- Center for Structural Heart Disease, Division of Cardiology, Henry Ford Health System, Detroit, Michigan, USA
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Racial and regional disparity in liver transplant allocation. Surgery 2018; 163:612-616. [DOI: 10.1016/j.surg.2017.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 11/17/2022]
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Graham G. Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes. Clin Cardiol 2016; 39:299-306. [PMID: 27028198 DOI: 10.1002/clc.22524] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/13/2016] [Indexed: 01/01/2023] Open
Abstract
In the United States, different races, ethnicities, and their subgroups experience disparities regarding acute coronary syndrome (ACS) and myocardial infarction (MI). This review highlights these differences across 4 stages that comprise the ACS/MI narrative: (1) patient demographics, (2) patient comorbidities and health risks, (3) treatments and their delays, and (4) outcomes. Overall, black and Hispanic ACS/MI patients are more likely to present with comorbidities, experience longer delays before treatment, and suffer worse outcomes when compared with non-Hispanic white patients. More specifically, across the studies analyzed, black and Hispanic ACS/MI patients were consistently more likely to be younger or female, or to have hypertension or diabetes, than non-Hispanic white patients. ACS/MI disparities also exist among Asian populations, and these are briefly outlined. However, black, Hispanic, and non-Hispanic white ACS/MI patients were the 3 most-studied racial and ethnic groups, indicating that additional studies of other minority groups, such as Native Americans, Asian populations, and black and Hispanic subgroups, are needed for their utility in reducing disparities. Despite notable improvement in ACS/MI treatment quality measures over recent decades, disparities persist. Causes are complex and extend beyond the healthcare system to culture and patients' personal characteristics; sophisticated solutions will be required. Continued research has the potential to further reduce or eliminate disparities in the comorbidities, delays, and treatments surrounding ACS and MI, extending healthy lifespans of many underserved and minority populations, while reducing healthcare costs.
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Affiliation(s)
- Garth Graham
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut.,Aetna Foundation, Aetna Inc., Hartford, Connecticut
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Graham G, Xiao YYK, Rappoport D, Siddiqi S. Population-level differences in revascularization treatment and outcomes among various United States subpopulations. World J Cardiol 2016; 8:24-40. [PMID: 26839655 PMCID: PMC4728105 DOI: 10.4330/wjc.v8.i1.24] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/29/2015] [Accepted: 11/04/2015] [Indexed: 02/06/2023] Open
Abstract
Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to understand the extent of disparities in treatment in these subpopulations.
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Differences in the rates of patient safety events by payer: implications for providers and policymakers. Med Care 2015; 53:524-9. [PMID: 25906014 DOI: 10.1097/mlr.0000000000000363] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The reduction of adverse patient safety events and the equitable treatment of patients in hospitals are clinical and policy priorities. Health services researchers have identified disparities in the quality of care provided to patients, both by demographic characteristics and insurance status. However, less is known about the extent to which disparities reflect differences in the places where patients obtain care, versus disparities in the quality of care provided to different groups of patients in the same hospital. OBJECTIVE In this study, we examine whether the rate of adverse patient safety events differs by the insurance status of patients within the same hospital. METHODS Using discharge data from hospitals in 11 states, we compared risk-adjusted rates for 13 AHRQ Patient Safety Indicators by Medicare, Medicaid, and Private payer insurance status, within the same hospitals. We used multivariate regression to assess the relationship between insurance status and rates of adverse patient safety events within hospitals. RESULTS Medicare and Medicaid patients experienced significantly more adverse safety events than private pay patients for 12 and 7 Patient Safety Indicators, respectively (at P < 0.05 or better). However, Medicaid patients had significantly lower event rates than private payers on 2 Patient Safety Indicators. CONCLUSIONS Risk-adjusted Patient Safety Indicator rates varied with patients' insurance within the same hospital. More research is needed to determine the cause of differences in care quality received by patients at the same hospital, especially if quality measures are to be used for payment.
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Grobman WA, Bailit JL, Rice MM, Wapner RJ, Reddy UM, Varner MW, Thorp JM, Leveno KJ, Caritis SN, Iams JD, Tita ATN, Saade G, Rouse DJ, Blackwell SC, Tolosa JE, VanDorsten JP. Racial and ethnic disparities in maternal morbidity and obstetric care. Obstet Gynecol 2015; 125:1460-1467. [PMID: 26000518 PMCID: PMC4443856 DOI: 10.1097/aog.0000000000000735] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether racial and ethnic disparities exist in obstetric care and adverse outcomes. METHODS We analyzed data from a cohort of women who delivered at 25 hospitals across the United States over a 3-year period. Race and ethnicity was categorized as non-Hispanic white, non-Hispanic black, Hispanic, or Asian. Associations between race and ethnicity and severe postpartum hemorrhage, peripartum infection, and severe perineal laceration at spontaneous vaginal delivery as well as between race and ethnicity and obstetric care (eg, episiotomy) relevant to the adverse outcomes were estimated by univariable analysis and multivariable logistic regression. RESULTS Of 115,502 studied women, 95% were classified by one of the race and ethnicity categories. Non-Hispanic white women were significantly less likely to experience severe postpartum hemorrhage (1.6% non-Hispanic white compared with 3.0% non-Hispanic black compared with 3.1% Hispanic compared with 2.2% Asian) and peripartum infection (4.1% non-Hispanic white compared with 4.9% non-Hispanic black compared with 6.4% Hispanic compared with 6.2% Asian) than others (P<.001 for both). Severe perineal laceration at spontaneous vaginal delivery was significantly more likely in Asian women (2.5% non-Hispanic white compared with 1.2% non-Hispanic black compared with 1.5% Hispanic compared with 5.5% Asian; P<.001). These disparities persisted in multivariable analysis. Many types of obstetric care examined also were significantly different according to race and ethnicity in both univariable and multivariable analysis. There were no significant interactions between race and ethnicity and hospital of delivery. CONCLUSION Racial and ethnic disparities exist for multiple adverse obstetric outcomes and types of obstetric care and do not appear to be explained by differences in patient characteristics or by delivery hospital. LEVEL OF EVIDENCE II.
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Affiliation(s)
- William A Grobman
- Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio; Columbia University, New York, New York; University of Utah Health Sciences Center, Salt Lake City, Utah; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the University of Texas Southwestern Medical Center, Dallas, Texas; the University of Pittsburgh, Pittsburgh, Pennsylvania; The Ohio State University, Columbus, Ohio; the University of Alabama at Birmingham, Birmingham, Alabama; the University of Texas Medical Branch, Galveston, Texas; Brown University, Providence, Rhode Island; the University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas; Oregon Health & Science University, Portland, Oregon; the Medical University of South Carolina, Charleston, South Carolina; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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