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JAMA Dec 2023The effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown. (Comparative Study)
Comparative Study
IMPORTANCE
The effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown.
OBJECTIVE
To examine changes in hospital-acquired adverse events and hospitalization outcomes associated with private equity acquisitions of US hospitals.
DESIGN, SETTING, AND PARTICIPANTS
Data from 100% Medicare Part A claims for 662 095 hospitalizations at 51 private equity-acquired hospitals were compared with data for 4 160 720 hospitalizations at 259 matched control hospitals (not acquired by private equity) for hospital stays between 2009 and 2019. An event study, difference-in-differences design was used to assess hospitalizations from 3 years before to 3 years after private equity acquisition using a linear model that was adjusted for patient and hospital attributes.
MAIN OUTCOMES AND MEASURES
Hospital-acquired adverse events (synonymous with hospital-acquired conditions; the individual conditions were defined by the US Centers for Medicare & Medicaid Services as falls, infections, and other adverse events), patient mix, and hospitalization outcomes (including mortality, discharge disposition, length of stay, and readmissions).
RESULTS
Hospital-acquired adverse events (or conditions) were observed within 10 091 hospitalizations. After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% CI, 2.0-7.2] additional hospital-acquired conditions per 10 000 hospitalizations, P = .004). This increase in hospital-acquired conditions was driven by a 27.3% increase in falls (P = .02) and a 37.7% increase in central line-associated bloodstream infections (P = .04) at private equity hospitals, despite placing 16.2% fewer central lines. Surgical site infections doubled from 10.8 to 21.6 per 10 000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume; meanwhile, such infections decreased at control hospitals, though statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations. Compared with Medicare beneficiaries treated at control hospitals, those treated at private equity hospitals were modestly younger, less likely to be dually eligible for Medicare and Medicaid, and more often transferred to other acute care hospitals after shorter lengths of stay. In-hospital mortality (n = 162 652 in the population or 3.4% on average) decreased slightly at private equity hospitals compared with the control hospitals; there was no differential change in mortality by 30 days after hospital discharge.
CONCLUSIONS AND RELEVANCE
Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line-associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections. Shifts in patient mix toward younger and fewer dually eligible beneficiaries admitted and increased transfers to other hospitals may explain the small decrease in in-hospital mortality at private equity hospitals relative to the control hospitals, which was no longer evident 30 days after discharge. These findings heighten concerns about the implications of private equity on health care delivery.
Topics: Aged; Humans; Hospitals, Private; Iatrogenic Disease; Medicare; Sepsis; Surgical Wound Infection; United States; Outcome Assessment, Health Care; Quality of Health Care; Hospitalization; Medicare Part A
PubMed: 38147093
DOI: 10.1001/jama.2023.23147 -
Revue Neurologique Dec 2023
Topics: Humans; Medical Assistance; Nervous System Diseases; Suicide, Assisted
PubMed: 37500353
DOI: 10.1016/j.neurol.2023.03.021 -
Neurology Nov 2023
Topics: Humans; United States; Prior Authorization; Medicaid; Reimbursement Mechanisms
PubMed: 37648531
DOI: 10.1212/WNL.0000000000207790 -
CMAJ : Canadian Medical Association... Sep 2023
Topics: Humans; Medical Assistance; Tissue and Organ Procurement
PubMed: 37722743
DOI: 10.1503/cmaj.230108-f -
JAMA Network Open Sep 2023Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for...
IMPORTANCE
Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations.
OBJECTIVE
To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023.
EXPOSURE
Differential state-level public assistance spending.
MAIN OUTCOME AND MEASURE
The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage.
RESULTS
A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P < .001), particularly for non-Hispanic Black individuals (0.29% [95% CI, 0.07%-0.52%] per $100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P < .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49% [95% CI, 0.26%-0.72%] per $100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects).
CONCLUSIONS AND RELEVANCE
This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation.
Topics: Adult; Aged; Female; Humans; Male; Cohort Studies; Ethnicity; Neoplasms; Public Assistance; Survival Rate; United States; Black or African American
PubMed: 37669050
DOI: 10.1001/jamanetworkopen.2023.32353 -
Health Affairs (Project Hope) Sep 2023
Topics: Aged; Humans; United States; Medicare; Costs and Cost Analysis
PubMed: 37669489
DOI: 10.1377/hlthaff.2023.01068 -
Health Systems in Transition Jul 2023This review of the French health system analyses recent developments in health organisation and governance, financing, healthcare provision, recent reforms and health... (Review)
Review
This review of the French health system analyses recent developments in health organisation and governance, financing, healthcare provision, recent reforms and health system performance. Overall health status continues to improve in France, although geographic and socioeconomic inequalities in life expectancy persist. The health system combines a social health insurance (SHI) model with an important role for tax-based revenues to finance healthcare. The health system provides universal coverage, with a broad benefits basket, but cost-sharing is required for all essential services. Private complementary insurance to cover these costs results in very low average out-of-pocket (OOP) payments, although there are concerns regarding solidarity, financial redistribution and efficiency in the health system. The macroeconomic context in the last couple of years in the country has been affected by the Covid-19 pandemic, which resulted in subsequent increases of total health expenditure in France in 2020 (3.7%) and 2021 (9.8%). Healthcare provision continues to be highly fragmented in France, with a segmented approach to care organization and funding across primary, secondary and long-term care. Recent reforms aim to strengthen primary care by encouraging multidisciplinary group practices, while public health efforts over the last decade have focused on boosting prevention strategies and tackling lifestyle risk factors, such as smoking and obesity with limited success. Continued challenges include ensuring the sustainability of the health workforce, particularly to secure adequate numbers of health professionals in medically underserved areas, such as rural and less affluent communities, and improving working conditions, remuneration and career prospects, especially for nurses, to support retention. The Covid-19 pandemic has brought to light some structural weaknesses within the French health system, but it has also provided opportunities for improving its sustainability. There has been a notable shift in the will to give more room to decision-making at the local level, involving healthcare professionals, and to find new ways of funding healthcare providers to encourage care coordination and integration.
Topics: Humans; Pandemics; COVID-19; Medical Assistance; Insurance, Health; France
PubMed: 37489947
DOI: No ID Found -
American Journal of Health-system... Oct 2023
Topics: Humans; United States; Vulnerable Populations; Socioeconomic Factors; Medicare
PubMed: 37471148
DOI: 10.1093/ajhp/zxad160 -
American Journal of Public Health Dec 2023
Topics: United States; Humans; Medicaid; Public Health; Population Health Management; Smoking Cessation; Smokers
PubMed: 37856728
DOI: 10.2105/AJPH.2023.307466 -
Health Affairs (Project Hope) Mar 2024
Topics: United States; Humans; Medicaid; Nursing Homes; Physicians
PubMed: 38437613
DOI: 10.1377/hlthaff.2024.00221