Lack of a substantive effect of insurance and the national US payment system on the relative distribution of surgical cases among hospitals in the State of Iowa: A retrospective, observational, cohort study

摘要

Study objectiveOur aim was to quantify the extent to which the distribution of patients among payers and changes to the payers' policies has influenced the market of surgery among hospitals in a relatively rural state. DesignRetrospective cohort study. SettingIowa Hospital Association data analyzed were from 2007 through 2016 for the N?=?121 hospitals with at least one case performed that included a major therapeutic procedure. MeasurementsWe used five categories of payer (e.g., Medicare), five categories of patient age (e.g., 18 to 64?years), and three categories of patient residence location (e.g., neither from the county of the hospital nor from a county contiguous to the county of the hospital). Main resultsSorting hospitals in descending sequence of numbers of surgical cases, depending on year, the top 10% of hospitals performed 58.4% to 59.2% of the cases. Increases in numbers of cases among patients with commercial insurance increased the heterogeneity among hospitals in numbers of surgical cases (P?