Health Equity and Hospital Markets
Differences in the Association of Market Concentration and Quality of Care by Patient Race/Ethnicity and Payer
Datos Bibliográficos
| ID | 9103685 |
|---|---|
| Autores | Alexander C Adia (0000-0002-8879-8269, School of Public Health, University of California, Berkeley, Berkeley, CA, autor de correspondencia), Charleen Hsuan (0000-0001-8720-2323, Department of Health Policy & Administration, Pennsylvania State University, University Park, PA), Hector P Rodriguez (0000-0002-6564-2229, School of Public Health, University of California, Berkeley, Berkeley, CA, autor de correspondencia) |
| Año | 2025 |
| Volumen | 63 |
| Número | 8 |
| Páginas | 565-572 |
| Fecha de publicación | 2025-08-01 |
| Peer Reviewed | Sí |
| Open Access | Sí |
| Tipo | ARTICLE |
| Revista | Medical Care (JOURNAL) |
| Identificadores de la revista | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Editorial | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000002123 |
| PMID | 40100035 |
| OpenAlex | W4408573855 |
| Idioma | EN |
| Referencias citadas | 24 |
BACKGROUND: As hospital markets become increasingly consolidated, whether regulators should account for consolidation's impacts on health equity has become a key policy question. We assess the association of hospital market concentration with quality of care and examine differences by patient race/ethnicity and payer. METHODS: We analyzed linked 2017 American Hospital Association Annual Survey and Healthcare Cost and Utilization Project State Inpatient Data from 14 US states. Market concentration was measured using the Herfindahl-Hirschman Index (HHI) at the county level, and quality was assessed using the Prevention Quality Indicators (PQI). We assessed the relationship of HHI, patient race/ethnicity, and payer with having any PQI admission, controlling for patient and hospital characteristics. We used interaction terms for race-HHI and payer-HHI to assess differential associations of concentration by race/ethnicity and payer using linear probability models. RESULTS: In adjusted analyses, minoritized racial/ethnic group status and having a noncommercial primary payer were associated with a higher probability of having a PQI admission. Differences between Hispanic adults and White adults decreased in more competitive markets but increased for Asian/Pacific Islander adults versus White adults. Differences in the probability of a PQI admission between adults covered by Medicaid and self-pay/no-pay adults versus commercially insured adults increased, while differences for adults covered by Medicare decreased. CONCLUSIONS: Hospital market concentration may have heterogeneous effects on the quality of care by patient race/ethnicity and payer. Because market concentration may impact equity, regulators should consider accounting for health equity impacts in merger reviews
Business · Economics · Equity (law) · Ethnic group · Family medicine · Health care · Health equity · Medicaid · Political science · Public health · Race (biology) · Demography · Healthcare Policy and Management · Medicine · Nursing · Patient Satisfaction in Healthcare · Primary Care and Health Outcomes
| Velocidad de citación | historical |
|---|---|
| Altamente citado | No |