title: Insurance status and the transfer of hospitalized patients: an observational study.
abstract: BACKGROUND
  There is little objective evidence to support concerns that patients are transferred between hospitals based on insurance status.
  
  
  OBJECTIVE
  To examine the relationship between patients' insurance coverage and interhospital transfer.
  
  
  METHODS
  Data analyzed from the 2010 Nationwide Inpatient Sample.
  
  
  METHODS
  All patients aged 18 to 64 years discharged alive from U.S. acute care hospitals with 1 of 5 common diagnoses (biliary tract disease, chest pain, pneumonia, septicemia, and skin or subcutaneous infection).
  
  
  METHODS
  For each diagnosis, the proportion of hospitalized patients who were transferred to another acute care hospital based on insurance coverage (private, Medicare, Medicaid, or uninsured) was compared. Logistic regression was used to estimate the odds of transfer for uninsured patients (reference category, privately insured) while patient- and hospital-level factors were adjusted for. All analyses incorporated sampling and poststratification weights.
  
  
  RESULTS
  Among 315 748 patients discharged from 1051 hospitals with any of the 5 diagnoses, the percentage of patients transferred to another acute care hospital varied from 1.3% (skin infection) to 5.1% (septicemia). In unadjusted analyses, uninsured patients were significantly less likely to be transferred for 3 diagnoses (P 0.05). In adjusted analyses, uninsured patients were significantly less likely to be transferred than privately insured patients for 4 diagnoses: biliary tract disease (odds ratio, 0.73 [95% CI, 0.55 to 0.96]), chest pain (odds ratio, 0.63 [CI, 0.44 to 0.89]), septicemia (odds ratio, 0.76 [CI, 0.64 to 0.91]), and skin infections (odds ratio, 0.64 [CI, 0.46 to 0.89]). Women were significantly less likely to be transferred than men for all diagnoses.
  
  
  CONCLUSIONS
  This analysis relied on administrative data and lacked clinical detail.
  
  
  CONCLUSIONS
  Uninsured patients (and women) were significantly less likely to undergo interhospital transfer. Differences in transfer rates may contribute to health care disparities.
  
  
  BACKGROUND
  National Institutes of Health.
authors.forename: Janel
authors.initials: J
authors.lastname: Hanmer
authors.forename: Xin
authors.initials: X
authors.lastname: Lu
authors.forename: Gary E
authors.initials: GE
authors.lastname: Rosenthal
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D010360:Patient Transfer / Q000191:economics / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States