Disparities in the use of ambulatory surgical centers: a cross sectional study.
BACKGROUND
Ambulatory surgical centers (ASCs) provide outpatient surgical services more efficiently than hospital outpatient departments, benefiting patients through lower co-payments and other expenses. We studied the influence of socioeconomic status and race on use of ASCs.


METHODS
From the 2005 State Ambulatory Surgery Database for Florida, a cohort of discharges for urologic, ophthalmologic, gastrointestinal, and orthopedic procedures was created. Socioeconomic status was established at the zip code level. Logistic regression models were fit to assess associations between socioeconomic status and ASC use.


RESULTS
Compared to the lowest group, patients of higher socioeconomic status were more likely to have procedures performed in ASCs (OR 1.07 CI 1.05, 1.09). Overall, the middle socioeconomic status group was the most likely group to use the ASC (OR 1.23, CI 1.21 to 1.25). For whites and blacks, higher status is associated with increased ASC use, but for Hispanics this relationship was reversed (OR 0.84 CI 0.78, 0.91).


CONCLUSIONS
Patients of lower socioeconomic status treated with outpatient surgery are significantly less likely to have their procedures in ASCs, suggesting that less resourced patients are encountering higher cost burdens for care. Thus, the most economically vulnerable group is unnecessarily subject to higher charges for surgery.
Strope
Seth A
SA
Department of Urology, Division of Health Services Research, University of Michigan Health System, Ann Arbor, MI, USA. sethstro@umich.edu
Sarma
Aruna
A
Ye
Zaojun
Z
Wei
John T
JT
Hollenbeck
Brent K
BK
D003430:Cross-Sectional Studies; D003669:Deductibles and Coinsurance; D005431:Florida; D006801:Humans; D044469:Racial Groups; D012923:Social Class; D013531:Surgicenters / Q000191:economics / Q000706:statistics & numerical data*