The relationship of insurance status, hospital ownership, and teaching status with interhospital transfers in California in 2000.
OBJECTIVE
Public hospitals and academic medical centers may admit more poorly insured transfer patients than do other institutions. The authors investigated the relationship of patient insurance status, hospital ownership, and hospital teaching status with interhospital transfers in California.


METHODS
In 2003, data were derived from the hospital discharge abstract database for the year 2000 from the California Office of Statewide Health Planning and Development. Hospitals were categorized by ownership and teaching status; patients were categorized as being "good" or "poor" payers depending on the level of expected insurance reimbursement. Descriptive and multivariate analyses were used to assess the number of poor payer transfers admitted by each hospital group.


RESULTS
In 2000, there were 58,509 transfer and 2,320,479 direct admissions. All hospital groups admitted a higher percentage of good payer than poor payer transfer patients (85% vs. 15% respectively for all groups combined). Adjusted for total number of admissions and teaching status, the number of poor payer transfer patients admitted to county-owned and University of California hospitals was significantly higher than the statewide average (both p values < .001), while the number admitted to independent teaching hospitals was significantly lower than the statewide average (p < .001). The number of poor payer transfer patients admitted to independent teaching hospitals more closely resembled that of for-profit hospitals than that of University of California teaching hospitals.


CONCLUSIONS
In 2000, the likelihood of a hospital admitting a transfer patient appears to have been affected by both the patient's insurance status and the hospital's ownership. In general, good payer patients were more likely to be transferred than were poor payer patients, with poor payer transfer patients more likely to be admitted to publicly owned hospitals.
Green
Adrienne
A
Department of Medicine, School of Medicine, University of California-San Francisco, Box 0131, 533 Parnassus Avenue, San Francisco, CA 94143, USA. greena@medicine.ucsf.edu
Showstack
Jonathan
J
Rennie
Deborah
D
Goldman
Lee
L
D002140:California; D039702:Current Procedural Terminology; D006777:Hospitals, Proprietary / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000145:classification / Q000458:organization & administration / Q000706:statistics & numerical data*; D006788:Hospitals, Voluntary / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000145:classification* / Q000706:statistics & numerical data; D007350:Insurance, Hospitalization; D038801:International Classification of Diseases; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D010067:Ownership / Q000145:classification* / Q000706:statistics & numerical data; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000191:economics / Q000706:statistics & numerical data*