Back to Search
Start Over
Choice of hospital for delivery: a comparison of high-risk and low-risk women.
- Source :
-
Health services research [Health Serv Res] 1993 Jun; Vol. 28 (2), pp. 201-22. - Publication Year :
- 1993
-
Abstract
- Objective: This article tests whether or not the factors that affect hospital choice differ for selected subgroups of the population.<br />Data Sources: 1985 California Office of Statewide Health Planning and Development (OSHPD) discharge abstracts and hospital financial data were used.<br />Study Design: Models for hospital choice were estimated using McFadden's conditional logit model. Separate models were estimated for high-risk and low-risk patients, and for high-risk and low-risk women covered either by private insurance or by California Medicaid. The model included independent variables to control for quality, price, ownership, and distance to the hospital.<br />Data Extraction: Data covered all maternal deliveries in the San Francisco Bay Area in 1985 (N = 61,436). ICD-9 codes were used to classify patients as high-risk or low-risk. The expected payment code on the discharge abstract was used to identify insurance status.<br />Principal Findings: The results strongly reject the hypothesis that high-risk and low-risk women have the same choice process. Hospital quality tended to be more important for high-risk than low-risk women. These results also reject the hypothesis that factors influencing choice of hospital are the same for women covered by private insurance as for those covered by Medicaid. Further, high-risk women covered by Medicaid were less likely than high-risk women covered by private insurance to deliver in hospitals with newborn intensive care units.<br />Conclusions: The results show that the choice factors vary across several broadly defined subgroups of patients with a specific condition. Thus, estimates aggregating all patients may be misleading. Specifically, such estimates will understate actual patient response to quality of care indicators, since patient sensitivity to quality of care varies with the patients' risk status.
- Subjects :
- Choice Behavior
Fees and Charges
Female
Humans
Insurance, Hospitalization
Medicaid
Models, Statistical
Obstetric Labor Complications economics
Obstetric Labor Complications epidemiology
Obstetrics and Gynecology Department, Hospital standards
Ownership
Pregnancy
Quality of Health Care economics
Quality of Health Care statistics & numerical data
Regression Analysis
Risk Factors
San Francisco epidemiology
Socioeconomic Factors
United States
Delivery, Obstetric economics
Delivery, Obstetric statistics & numerical data
Obstetric Labor Complications therapy
Obstetrics and Gynecology Department, Hospital statistics & numerical data
Patient Satisfaction statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 0017-9124
- Volume :
- 28
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Health services research
- Publication Type :
- Academic Journal
- Accession number :
- 8514500