title: Patient cost-sharing and insurance arrangements are associated with hospital readmissions after abdominal surgery: Implications for access and quality health care.
abstract: BACKGROUND
  Readmission rates after operative procedures are used increasingly as a measure of hospital care quality. Patient access to care may influence readmission rates. The objective of this study was to determine the relationship between patient cost-sharing, insurance arrangements, and the risk of postoperative readmissions.
  
  
  METHODS
  Using the MarketScan Research Database (n = 121,002), we examined privately insured, nonelderly patients who underwent abdominal surgery in 2010. The main outcome measures were risk-adjusted unplanned readmissions within 7 days and 30 days of discharge. Odds of readmissions were compared with multivariable logistic regression models.
  
  
  RESULTS
  In adjusted models, $1,284 increase in patient out-of-pocket payments during index admission (a difference of one standard deviation) was associated with 19% decrease in the odds of 7-day readmission (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.78-0.85) and 17% decrease in the odds of 30-day readmission (OR 0.83, 95% CI 0.81-0.86). Patients in the noncapitated point-of-service plans (OR 1.19, 95% CI 1.07-1.33), preferred provider organization plans (OR 1.11, 95% CI 1.03-1.19), and high-deductible plans (OR 1.12, 95% CI 1.00-1.26) were more likely to be readmitted within 30 days compared with patients in the capitated health maintenance organization and point-of-service plans.
  
  
  CONCLUSIONS
  Among privately insured, nonelderly patients, increased patient cost-sharing was associated with lower odds of 7-day and 30-day readmission after abdominal surgery. Insurance arrangements also were significantly associated with postoperative readmissions. Patient cost sharing and insurance arrangements need consideration in the provision of equitable access for quality care.
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA.
authors.forename: Bora
authors.initials: B
authors.lastname: Youn
authors.affiliation: Center for the Assessment of Pharmaceutical Practices (CAPP), Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
authors.forename: Marina
authors.initials: M
authors.lastname: Soley-Bori
authors.affiliation: Center for the Assessment of Pharmaceutical Practices (CAPP), Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
authors.forename: Rene
authors.initials: R
authors.lastname: Soria-Saucedo
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Ryan
authors.affiliation: Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Schneider
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA; Ariadne Labs, Harvard School of Public Health and Brigham and Women's Hospital, Boston, MA.
authors.forename: Alex B
authors.initials: AB
authors.lastname: Haynes
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Cabral
authors.affiliation: Center for the Assessment of Pharmaceutical Practices (CAPP), Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Electronic address: lek@bu.edu.
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D017047:Cost Sharing / Q000191:economics*; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data; D019095:Point-of-Care Systems / Q000191:economics; D011787:Quality of Health Care; D014481:United States; D055815:Young Adult