Weissman J, Epstein A M
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115.
JAMA. 1989;261(24):3572-6.
Rising competitive pressures may place uninsured patients at risk for receiving fewer services than insured patients with similar medical conditions. To examine this possibility we studied the case mix, length of stay, and number of procedures for 65,032 patients listed as self-pay or free care, Blue Cross, or Medicaid at 52 hospitals in the Boston, Mass, area during 1983. We found that the overall case mix severity index (based on expected length of stay per diagnosis related group) for uninsured patients was 30% higher in public hospitals and 8% higher in major teaching hospitals compared with other institutions. Across all hospitals, the severity index of uninsured patients was similar to that of insured patients. However, after adjusting for diagnosis related group case mix, uninsured patients had, on average, 7% shorter stays (5.36 vs 5.79 days) and underwent 7% fewer procedures (1.16 vs 1.25) than Blue Cross patients, the differences varying with hospital type. Uninsured patients also had shorter stays on average than Medicaid patients (5.36 vs 5.87 days), but they underwent a similar number of procedures. These results suggest that patients who lack insurance may receive unequal treatment even after being hospitalized.
日益增加的竞争压力可能使未参保患者比患有相似疾病的参保患者获得更少的医疗服务。为了探究这种可能性，我们研究了1983年马萨诸塞州波士顿地区52家医院中65032例列为自费或免费医疗、蓝十字医保或医疗补助的患者的病例组合、住院时长及手术数量。我们发现，与其他机构相比，公立医院中未参保患者的总体病例组合严重程度指数（基于每个诊断相关组的预期住院时长）高出30%，在大型教学医院中高出8%。在所有医院中，未参保患者的严重程度指数与参保患者相似。然而，在对诊断相关组病例组合进行调整后，未参保患者的平均住院时间比蓝十字医保患者短7%（5.36天对5.79天），手术数量少7%（1.16次对1.25次），差异因医院类型而异。未参保患者的平均住院时间也比医疗补助患者短（5.36天对5.87天），但手术数量相近。这些结果表明，即使住院后，未参保患者可能仍会受到不平等的治疗。
