*Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan †Department of Health Administration, Virginia Commonwealth University, Richmond, VA ‡Department of Health Management and Policy, University of North Texas Health Science Center, Fort Worth, TX §Department of Economics, Virginia Commonwealth University, Richmond, VA.
Med Care. 2014 May;52(5):415-21. doi: 10.1097/MLR.0000000000000114.
Medicaid Disproportionate Share Hospital (DSH) payments are one of the major sources of financial support for hospitals providing care to low-income patients. However, Medicaid DSH payments will be redirected from hospitals to subsidize individual health insurance purchase through US national health reform.
The purpose of this study is to examine the association between Medicaid DSH payment reductions and nursing-sensitive and birth-related quality of care among Medicaid/uninsured and privately insured patients.
Economic theory of hospital behavior was used as a conceptual framework, and longitudinal data for California hospitals from 1996 to 2003 were examined. Hospital-fixed effects regression models were estimated. The unit of analysis is at the hospital level, examining 2 aggregated measures based on the payer category of discharged patients (ie, Medicaid/uninsured and privately insured).
The overall study findings provide at best weak evidence of an association between net Medicaid DSH payments and hospital quality of care for either Medicaid/uninsured or the privately insured patients. The magnitudes of the effects are small and only a few have significant DSH effects.
Although this study does not find evidence suggesting that reducing Medicaid DSH payments had a strong negative impact on hospital quality of care for Medicaid/uninsured or privately insured patients, the results are not necessarily predictive of the impact national health care reform will have. Research is necessary to monitor hospital quality of care as this reform is implemented.
医疗补助计划（Medicaid）的超额负担医院（DSH）拨款是为低收入患者提供医疗服务的医院的主要资金来源之一。然而，随着美国国家医疗改革的实施，这些 Medicaid DSH 拨款将从医院转移，用于补贴个人医疗保险购买。
本研究旨在考察 Medicaid DSH 拨款减少与护理敏感和与分娩相关的医疗质量之间的关联，研究对象为 Medicaid/无保险和私人保险患者。
采用医院行为的经济理论作为概念框架，分析了 1996 年至 2003 年加利福尼亚州医院的纵向数据。使用医院固定效应回归模型进行估计。分析单位为医院级别，根据出院患者的支付类别（即 Medicaid/无保险和私人保险）检查了 2 个聚合指标。
总体研究结果表明，Medicaid DSH 净拨款与 Medicaid/无保险或私人保险患者的医院医疗质量之间的关联仅提供了最微弱的证据。影响的幅度很小，只有少数具有显著的 DSH 效应。
尽管本研究没有发现证据表明减少 Medicaid DSH 拨款对 Medicaid/无保险或私人保险患者的医院医疗质量有强烈的负面影响，但这些结果不一定能预测国家医疗改革将产生的影响。有必要在实施这项改革的过程中进行研究，以监测医院的医疗质量。
