Impact of Insurance and Hospital Ownership on Hospital Length of Stay Among Patients With Ambulatory Care–Sensitive Conditions

Arch G. Mainous; Vanessa A. Diaz; Charles J. Everett; Michele E. Knoll

doi:10.1370/afm.1315

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The perversity of economic incentives for hospitals
John J. Frey

Published on: 04 January 2012

Published on: (4 January 2012)
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The perversity of economic incentives for hospitals
John J. Frey, Family Physician
I had a recent experience that might confirm an alternative interpretation offered by Mainous and colleagues for shorter hospital stays for uninsured patients with similar illness profiles compared to insured patients. When I was talking with a hospital administrator about an effort to decrease unnecessary rehospitalizations in a vulnerable population, he replied with dismay "you can't do that! We depend on those hospit...
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I had a recent experience that might confirm an alternative interpretation offered by Mainous and colleagues for shorter hospital stays for uninsured patients with similar illness profiles compared to insured patients. When I was talking with a hospital administrator about an effort to decrease unnecessary rehospitalizations in a vulnerable population, he replied with dismay "you can't do that! We depend on those hospitalizations." I was shocked a bit but probably shouldn't be. Hospitals use revenues from insured patients to offset those from uninsured and the federally required Community Benefits program for non- profit hospitals is used, in many cases, to fill holes in coverage for Medicare patients rather than true community care for uninsured. "Saving money" by decreasing avoidable hospitalizations, even though the correct direction for cost savings and improving quality, once again conflicts with the current method of paying for hospitalization. Thus, one rationale for Mainous and colleagues' findings may be keeping insured patients longer to increase revenues for hospitals.
Competing interests: None declared
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Competing Interests: None declared.