Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Netw Open. 2020 Jan 3;3(1):e1920053. doi: 10.1001/jamanetworkopen.2019.20053.
Access to reproductive health services is a public health goal. It is unknown how geographic and health plan network availability of Catholic and non-Catholic hospitals may be associated with access to reproductive health services in the United States.
To characterize the market share of Catholic hospitals in the United States, both overall and within Marketplace health insurance plans' hospital networks.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of US counties used data on hospitals' Catholic affiliation and discharges, hospital networks in Marketplace health insurance plans, and US Census population data to construct a national, county-level data set. The Catholic hospital market share overall in each county and in Marketplace plans' hospital networks in each county were calculated. The study examined whether the Catholic hospital market share was different within Marketplace networks compared with the counties they served. Data analysis was conducted in May and June 2018.
The overall Catholic hospital market share was calculated on the basis of the share of discharges in Catholic hospitals in a county compared with all hospital discharges. Overall market share was categorized as minimal (≤2%), low (>2% to ≤20%), high (>20% to ≤70%), or dominant (>70%). The Catholic hospital market share in Marketplace networks was calculated as the share of Catholic hospital discharges in each Marketplace network.
The sample included 4450 hospitals in 3101 counties. Overall, 26.1% of US counties had minimal Catholic hospital market share, 38.6% had low Catholic hospital market share, and 35.3% had high or dominant Catholic hospital market share; 38.7% of US reproductive-aged women resided in counties with high or dominant Catholic hospital market share. Among counties with Catholic hospital market share greater than 2%, the distribution of the median Marketplace network's Catholic hospital market share (median [interquartile range], 4.6% [0%-24.3%]) was lower than overall Catholic hospital market share (median [interquartile range], 18.5% [8.1%-36.5%]). The median Marketplace hospital network had a lower Catholic hospital market share than the county overall in 68.0% of US counties with Catholic hospital market share greater than 2%.
In this national study, 35.3% of counties had high or dominant Catholic hospital market share serving an estimated 38.7% of US women of reproductive age. Marketplace health insurance plans' hospital networks included a lower share of Catholic hospitals than the counties they serve.
获得生殖健康服务是公共卫生的目标。目前尚不清楚天主教和非天主教医院的地理位置和医疗计划网络的可用性与美国获得生殖健康服务的情况有何关联。
描述美国天主教医院的市场份额，包括整体情况以及市场健康保险计划医院网络内的情况。
设计、地点和参与者：这项对美国各县的横断面研究使用了有关医院天主教隶属关系和出院情况、市场健康保险计划医院网络以及美国人口普查人口数据的信息，构建了一个全国性的县一级数据集。计算了每个县的整体天主教医院市场份额以及每个县的市场健康保险计划医院网络中的份额。研究考察了天主教医院在市场网络中的市场份额与他们服务的县内是否存在差异。数据分析于 2018 年 5 月和 6 月进行。
根据一个县的天主教医院出院人数与所有医院出院人数的比例计算整体天主教医院市场份额。整体市场份额分为低（≤2%）、中（>2%≤20%）、高（>20%≤70%）和高（>70%）。市场网络中的天主教医院市场份额是根据每个市场网络的天主教医院出院人数计算的。
样本包括 3101 个县的 4450 家医院。总体而言，26.1%的美国县的天主教医院市场份额较低，38.6%的县的天主教医院市场份额较低，35.3%的县的天主教医院市场份额较高或主导地位；38.7%的美国育龄妇女居住在天主教医院市场份额较高或主导地位的县。在天主教医院市场份额大于 2%的县中，中位数（四分位距）市场网络中天主教医院市场份额（中位数[四分位距]，4.6%[0%24.3%]）低于整体天主教医院市场份额（中位数[四分位距]，18.5%[8.1%36.5%]）。在天主教医院市场份额大于 2%的县中，68.0%的县的市场网络中位数天主教医院市场份额低于全县中位数，中位数市场网络中位数天主教医院市场份额低于全县中位数。
在这项全国性研究中，35.3%的县拥有高或主导地位的天主教医院市场份额，估计有 38.7%的美国育龄妇女。市场健康保险计划的医院网络包括的天主教医院比例低于他们所服务的县。
