Health Insurance Hospitals Medicaid

Do safety net hospitals provide care strategically?

It is widely known that safety net hospitals provide less intensive care than hospitals whose patient base is mostly commercially-insured.  One question is whether safety net hospitals discriminate the care provided based on their patients insurance status.  In other words, do commerically insured individuals who visit safety net hospitals receive more care than patients treated at these same hospitals with no insurnce or who are covered by Medicaid?

Based on data from Virginia looking at surgery wait times and rates of breast re-construction surgery, the answer appears to be ‘no.’  A 2012 study by Bradley and co-authors finds the following:

There is little evidence to suggest that safety net hospitals attenuate treatment differences between insurance and racial groups. The time between diagnosis and surgery was longer in safety net hospitals for all patients, regardless of insurance source or race. Perhaps safety net hospitals are operating at capacity and are unable to schedule surgeries in a timely manner. If this is the case, their resources may be further stretched following the passage of the PPACA. Alternatively, as these hospitals are teaching hospitals, they may perform additional diagnostic tests prior to scheduling surgery or physicians who treat low-income patients may have a slower referral process.


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