title: Addressing Medicaid Expansion from the Perspective of Patient Experience in Hospitals.
abstract: More Medicaid holders are entering the healthcare system consequential to Medicaid expansion. Their experience has financial consequences for hospitals and crucial implications for the provision of patient-centered care. This study examined how the hospital characteristics, especially the rates of Medicaid coverage and racial/ethnic minorities, impact the quality of inpatient care.
  
  
  
  Using data for years 2009-2011 for 870 observations of California hospitals, and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems survey coupled with data from the Healthcare Cost and Utilization Project and American Hospital Association Annual Survey, we used a generalized estimating equation approach to evaluate patients' experience with hospital care. Our multivariate model includes a comprehensive set of characteristics capturing market, structural, process, and patient demographics associated with the patient's hospital stay.
  
  
  
  The findings indicate that high concentrations of Medicaid patients in the hospital negatively impact the perceived patient experience. In addition, all things being equal, hospitals with higher concentrations of Hispanic, Black, and Asian patients received lower patient satisfaction results on 28 of the 30 regression coefficients capturing patient satisfaction, with 22 of the 30 negative coefficients statistically significant.
  
  
  
  Hospitals serving higher concentrations of Medicaid patients and more racial/ethnic diverse patients experienced a less satisfactory patient experience than patients utilizing other payers or patients who were White. Our research magnifies the challenge for addressing the disparities that exist in healthcare. Further research is called for clarifying the underlying reasons for these disparities and the optimal strategies for addressing these problems.
authors.affiliation: College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Liu
authors.affiliation: College of Management, Chang Gung University, 259 Wen-Hua 1st Road, Kwei-Shan, Taoyuan, 333, Taiwan. ypwen@mail.cgu.edu.tw.
authors.forename: Yu-Ping
authors.identifier: 0000-0002-7306-2144
authors.initials: YP
authors.lastname: Wen
authors.affiliation: College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA.
authors.forename: Soumya
authors.initials: S
authors.lastname: Mohan
authors.affiliation: Nursing and Health Studies, Northern Illinois University, DeKalb, IL, USA.
authors.forename: Jaeyong
authors.initials: J
authors.lastname: Bae
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Edmund R
authors.initials: ER
authors.lastname: Becker
mesh_terms: D001213:Asian; D044383:Black People; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006761:Hospitals; D006801:Humans; D008484:Medicaid; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D014481:United States; D044465:White People; D001741:Black or African American