Choice of hospital for delivery: a comparison of high-risk and low-risk women.
OBJECTIVE
This article tests whether or not the factors that affect hospital choice differ for selected subgroups of the population.


METHODS
1985 California Office of Statewide Health Planning and Development (OSHPD) discharge abstracts and hospital financial data were used.


METHODS
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.


METHODS
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.


RESULTS
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.


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.
Center for Health Care Evaluation, VA Medical Center, Menlo Park, CA 94025.
C S
CS
Phibbs
D H
DH
Mark
H S
HS
Luft
D J
DJ
Peltzman-Rennie
D W
DW
Garnick
E
E
Lichtenberg
S J
SJ
McPhee
D002755:Choice Behavior; D036861:Delivery, Obstetric / Q000191:economics / Q000706:statistics & numerical data; D005249:Fees and Charges; D005260:Female; D006801:Humans; D007350:Insurance, Hospitalization; D008484:Medicaid; D015233:Models, Statistical; D007744:Obstetric Labor Complications / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D010067:Ownership; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011247:Pregnancy; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data; D012044:Regression Analysis; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States