Ls. Fisher et al., Associations among hospital capacity, utilization, and mortality of US medicare beneficiaries, controlling for sociodemographic factors, HEAL SERV R, 34(6), 2000, pp. 1351-1362
Citations number
26
Categorie Soggetti
Public Health & Health Care Science","Health Care Sciences & Services
Objective. To explore whether geographic variations in Medicare hospital ut
ilization rates are due to differences in local hospital capacity, after co
ntrolling for socioeconomic status and disease burden, and to determine whe
ther greater hospital capacity is associated with lower Medicare mortality
rates.
Data Sources/Study Setting. The study population: a 20 percent sample of 19
89 Medicare enrollees. Measures of resources were based on a national small
area analysis of 313 Hospital Referral Regions (HRR). Demographic and soci
oeconomic data were obtained from the 1990U.S. Census. Measures of local di
sease burden were developed using Medicare claims files.
Study Design. The study was a cross-sectional analysis of the relationship
between per capita measures of hospital resources in each region and hospit
al utilization and mortality rates among Medicare enrollees. Regression tec
hniques were used to control for differences in sociodemographic characteri
stics and disease burden across areas.
Data Collection/Extraction Methods. Data on the study population were obtai
ned from Medicare enrollment (Denominator File) and hospital claims files (
MedPAR) and U.S. Census files.
Principal Findings. The per capita supply of hospital beds varied by more t
han twofold across U.S. regions. Residents of areas with more beds were up
to 30 percent more likely to be hospitalized, controlling for ecologic meas
ures of socioeconomic characteristics and disease burden. A greater proport
ion of the population was hospitalized at least once during the year in are
as with more beds; death was also more likely to take place in an inpatient
setting. All effects were consistent across racial and income groups. Resi
dence in areas with greater levels of hospital resources was not associated
with a decreased risk of death.
Conclusions. Residence in areas of greater hospital capacity is associated
with substantially increased use of the hospital, even after controlling fo
r socioeconomic characteristics and illness burden. This increased use prov
ides no detectable mortality benefit.