Study: Hospitals less likely to transfer uninsured, women to another facility

Uninsured patients and women are much less likely to undergo interhospital transfer, a contributing factor in healthcare disparities, according to a new study in the Annals of Internal Medicine.

Researchers from the University of Pittsburgh School of Medicine, in collaboration with a team from the University of Iowa and University of Toronto, set out to examine the relationship between patients' insurance status and interhospital transfers by analyzing data from the 2010 Nationwide Inpatient Sample. They focused on patients between 18 and 64 years old who suffered from biliary tract disease, chest pain, pneumonia, septicemia and skin or subcutaneous infection.

The research team compared the proportion of patients who were transferred to another hospital by their insurance coverage--private, Medicare, Medicaid or uninsured. They used logistic regression to estimate the odds of transfer for uninsured patients, and adjusted for patient and hospital-level factors, according to the study abstract.

They found that of 315,748 patients discharged from 1,051 hospitals, the percentage of patients transferred to another acute care hospital ranged from 1.3 percent for skin infections to 5.1 percent for septicemia. Uninsured patients were significantly less likely to be transferred for three of the five diagnoses after unadjusted analysis. They also were significantly less likely than privately insured patients to be transferred for all diagnoses except pneumonia after adjusted analysis, according to the study.

Women were also significantly less likely to be transferred for all diagnoses than men, researchers discovered.

"We hypothesized that uninsured patients would be more likely to be transferred as hospitals tried to punt these unprofitable cases to other hospitals in the area. Our study showed this did not happen," said Janel Hanmer, M.D., Ph.D., assistant professor of medicine at Pitt's School of Medicine and lead author of the study said in a study announcement. "Instead, we found that uninsured patients (and women) were substantially less likely to be transferred, suggesting that perhaps both the uninsured and women are not being transferred when they should be."

A 2010 study found that compared with hospitalized patients who have insurance, uninsured patients were 52 percent more likely to die in the hospital after a heart attack and 49 percent more likely to die in the hospital after a stroke, FierceHealthcare previously reported. Patients on Medicaid were 21 percent more likely to die in the hospital while receiving treatment for pneumonia.

To learn more:
- here's the study abstract
- read the study announcement