美国非营利性、501(c)(3)医院 2010 至 2017 年期间，对医院、社区和州监管因素以及免费和折扣护理家庭收入资格限制之间的关联进行多层次混合效应回归分析。
A multilevel mixed-effects regression analysis of the association between hospital, community and state regulatory factors, and family income eligibility limits for free and discounted care among U.S. not-for-profit, 501(c)(3), hospitals, 2010 to 2017.
机构信息
Department of Health Services and Information Management, East Carolina University, Greenville, North Carolina, USA.
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, USA.
出版信息
BMC Health Serv Res. 2021 Mar 15;21(1):230. doi: 10.1186/s12913-021-06219-4.
BACKGROUND
Not-for-profit hospitals are facing an uncertain financial future, especially following the COVID-19 pandemic. Nevertheless, they are legally obligated to provide free and discounted health care services to communities. This study investigates the hospital, community, and state regulatory factors and whether these factors are associated with family income eligibility levels for free and discounted care.
METHODS
Data were sourced from Internal Revenue Service Form 990, several data files from the Centers for Medicare and Medicaid, demographic and community factors from the Census Bureau, supplemental files from The Hilltop Institute, Community Benefit Insight, and Kaiser Family Foundation. The study employs multilevel mixed-effects linear and ordered logit regressions to estimate the association between the hospital, community, state policies, and the hospital's family income eligibility limit for free and discounted care.
RESULTS
A plurality of hospitals (49.96%) offered a medium level of family income eligibility limit (160-200% of the federal poverty level (FPL)) for free care. In comparison, about 53% (52.94%) offered a low level (0-300 of FPL) eligibility limit for discounted care. Holding all else equal, hospitals designated as critical access, safety net, those in rural areas or located in disadvantaged areas were associated with an increased probability of offering low eligibility limits for free and discounted care. Hospitals in a joint venture, located in highly concentrated markets or states with minimum community benefits requirements, were associated with an increased probability of offering high eligibility limits.
CONCLUSION
State and community factors appear to be associated with the eligibility level for free and discounted care. Hospitals serving low-income or rural communities seem to offer the least relief. The federal and state policymakers might need to consider relief to these hospitals with a requirement for them to provide a specific set of minimum community benefits.
背景
非营利性医院正面临着不确定的财务未来，尤其是在 COVID-19 大流行之后。然而，他们依法有义务向社区提供免费和折扣的医疗保健服务。本研究调查了医院、社区和州监管因素，以及这些因素是否与免费和折扣护理的家庭收入资格水平相关。
方法
数据来自美国国税局的 Form 990、医疗保险和医疗补助中心的几个数据文件、人口普查局的人口统计和社区因素、The Hilltop Institute、Community Benefit Insight 和 Kaiser Family Foundation 的补充文件。该研究采用多层混合效应线性和有序逻辑回归来估计医院、社区、州政策与医院免费和折扣护理的家庭收入资格限制之间的关联。
结果
多数医院（49.96%）为免费护理提供了中等家庭收入资格限制（联邦贫困线（FPL）的 160-200%）。相比之下，约 53%（52.94%）为折扣护理提供了较低的资格限制（0-300 倍 FPL）。在其他条件相同的情况下，被指定为关键访问、医疗救助、位于农村地区或处于不利地区的医院与提供免费和折扣护理低资格限制的可能性增加有关。合资医院、位于高度集中市场或社区福利要求最低的州的医院与提供高资格限制的可能性增加有关。
结论
州和社区因素似乎与免费和折扣护理的资格水平相关。为低收入或农村社区服务的医院似乎提供的救济最少。联邦和州政策制定者可能需要考虑对这些医院进行救济，要求他们提供一套特定的最低社区福利。
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