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Surgery. 2016 Mar;159(3):919-29. doi: 10.1016/j.surg.2015.09.007. Epub 2015 Oct 23.

Patient cost-sharing and insurance arrangements are associated with hospital readmissions after abdominal surgery: Implications for access and quality health care.

Author information

1
Department of Biostatistics, Boston University School of Public Health, Boston, MA.
2
Center for the Assessment of Pharmaceutical Practices (CAPP), Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
3
Department of Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA.
4
Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA.
5
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.
6
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.

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.

CONCLUSION:

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.

PMID:
26477477
DOI:
10.1016/j.surg.2015.09.007
[Indexed for MEDLINE]

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