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Insurance status, sex may influence likelihood of interhospital transfer

Wednesday, February 05 2014 | Comments
Evidence Grade 0 What's This?
Nonmedical factors, such as insurance coverage and sex, appear to play an important role in determining which hospitalized patients undergo transfer from one acute care hospital to another, new data indicate.

To examine the relationship between patients' insurance coverage and interhospital transfer, investigators obtained discharge data from the Agency for Health Care Research and Quality's Nationwide Inpatient Sample for the year 2010. Information was collected on 315,748 patients aged 18 to 64 years who were discharged from 1,051 acute care hospitals with one of five common conditions: biliary tract disease, chest pain, pneumonia, septicemia and skin or subcutaneous infection.

According to the findings, 2.6 percent of the cohort were transferred between acute care hospitals. Transfer rates ranged from 1.3 percent for skin infections to 5.1 percent for septicemia.

Female patients were significantly less likely to be transferred than men were for all five diagnoses. Specifically, the transfer rate for women was 35 percent to 40 percent less than the transfer rate for men was.

In adjusted analyses, uninsured patients were significantly less likely than were privately insured patients to be transferred from one hospital to another for four conditions: biliary tract disease, chest pain, septicemia and skin infections. Though not statistically significant, the likelihood of uninsured patients being transferred for pneumonia was also lower.

"Although transferring hospitals would be predicted to want to transfer underinsured patients, receiving hospitals go to increasingly great lengths to avoid accepting underinsured patients," the study authors wrote.

"Although it is relatively easy to see an economic motivation for the lower transfer rates we saw for uninsured patients, economic factors are unlikely to account for the same in women," they added.

"Providers may be less likely to transfer female patients for various reasons--for example, they may take signs or symptoms in women less seriously than for men; this has been noted in previous research for women with chest pain. Further analyses are needed to better understand the cause of these differences."

The study findings were published in the January issue of Annals of Internal Medicine.

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