Variation in Cardiovascular Treatment by Hospital Ownership Type Open Access

Lin, Hollis (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/0g354f36q?locale=en
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Abstract

In recent years, policymakers have placed an increased focus on determining whether non-profit hospitals are providing societal benefits commensurate to their substantial tax benefits and subsidies. A number of recent studies have found that non-profit hospitals provide only marginally more uncompensated care and community benefits than for-profit hospitals, which has led policymakers to question whether the preferential tax treatment of non-profit hospitals is justified.

This study uses the case of drug-eluting stents - an innovative, but expensive, medical technology - to examine whether non-profit hospitals have made trade-offs between improving patient care and increasing profitability. The results of this study will give policymakers a greater understanding of whether non-profit hospitals are using surplus funds to provide improved patient care relative to for-profit and public hospitals.

I analyzed data collected from 2003 to 2010 from the Nationwide Inpatient Sample to assess whether hospital ownership type (i.e. whether a hospital was a for-profit, non-profit, or public hospital) predicted whether or not a patient would receive a drug-eluting stent. I also assessed whether the effect of hospital ownership type changed based on the patient's insurance status. Linear probability models were used to examine these relationships after controlling for relevant patient and hospital characteristics.

I found no evidence that patients who were treated at non-profit hospitals are more likely to receive a drug-eluting stent than those who were treated at for-profit or public hospitals. However, I found that patients who were on Medicaid or were uninsured had a decreased chance of receiving a drug-eluting stent if treated at either a for-profit or non-profit hospital instead of a public hospital. These results leads us to question whether the preferential tax treatment of non-profit hospitals is justified if non-profit hospitals do not provide a higher level of patient care than for-profit hospitals to these vulnerable subgroups.

Table of Contents

Table of Contents

Introduction.................................................................................................................... 1 Literature Review........................................................................................................ 2

Coronary Heart Disease and Coronary Revascularization Procedures...................... 2

Percutaneous Coronary Intervention and the Introduction of Bare-Metal Stents...... 2

Introduction of Drug-Eluting Stents.......................................................................... 3

Variation in Adoption and Use of Medical Technology by Hospital Ownership...... 6

Disparities and Practice Variation in Drug-Eluting Stent Use.................................... 8

Conclusion............................................................................................................... 9 Methods........................................................................................................................ 12 Dataset .................................................................................................................. 12 Study Design......................................................................................................... 13 Dependent Variable............................................................................................... 14 Independent Variables........................................................................................... 14 Research Questions and Hypothesis...................................................................... 18 Data Analysis........................................................................................................ 19 Results........................................................................................................................... 21 Descriptive Statistics.............................................................................................. 21 Figures................................................................................................................... 28

Linear Probability Model Estimates....................................................................... 29

Discussion.................................................................................................................... 35 Summary............................................................................................................... 35 Contribution to the Literature................................................................................. 35 Policy Implications................................................................................................ 37 Limitations............................................................................................................. 38 Future Research..................................................................................................... 39 Conclusion................................................................................................................... 39 References.................................................................................................................... 41

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