Hospital ownership and admission rates from the emergency department, evidence from Florida.

OBJECTIVE

In light of Department of Justice investigations of for-profit chains for over-admitting patients, we sought to evaluate whether for-profit hospitals are more likely to admit patients from the emergency department.

DATA SOURCES

We used statewide visit-level inpatient and emergency department records from Florida's Agency for Healthcare Administration for 2007-2019.

STUDY DESIGN

We calculated differences in admission rates between for-profit and other hospitals, adjusting for patient and hospital characteristics. We also estimated instrumental variables models using differential distance to a for-profit hospital as an instrument.

DATA COLLECTION/EXTRACTION METHODS: Our main analysis focuses on patients ages 65 and older treated in hospitals that primarily serve adults.

PRINCIPAL FINDINGS

Adjusted admission rates among patients ages 65 and older were 7.1 percentage points (95% CI: 5.1-9.1) higher at for-profit hospitals in 2019 (or 18.8% of the sample mean of 37.8%). Differences in admission rates have remained constant since 2009.

CONCLUSION

Our results are consistent with allegations that for-profit hospitals maintain lower admission thresholds to increase occupancy levels.