Use of high-, low-quality hospitals by uninsured

Editor's Note

Despite the Affordable Care Act, which was designed to improve access to care for patients without insurance, patients without insurance have lower use of high-quality hospitals, this study finds.

The probability of admission to high-quality hospitals was similar for patients with Medicaid (23.3%) and private insurance (23.0%), but was significantly lower for patients without insurance (19.8%).

Adjusting for demographic, socioeconomic, and clinical characteristics did not affect the results.

The analysis included Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project data on nearly 875,000 patients treated at more than 1,800 hospitals in 18 states.

Background: Research suggests that individuals with Medicaid or no insurance receive fewer evidence-based treatments and have worse outcomes than those with private insurance for a broad range of conditions. These differences may be due to patients' receiving care in hospitals of different qualit...