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Study: Uninsured Patients and Women Less Likely to be Transferred Between Hospitals

A recent study from the University of Pittsburgh School of Medicine found that uninsured patients with a variety of common medical diagnoses were less likely to be transferred between hospitals for treatment.

The study came about because an “urban myth” that uninsured patients were more likely to be transferred persisted, yet there was no hard data to back it up.

“We were surprised to find that uninsured were actually less likely to be transferred than their insured counterparts, so totally the opposite of what we expected to find,” said Janel Hanmer, assistant professor of medicine and lead author of the study. “We also found that women were less likely to be transferred than men in all the conditions that we looked at.

The implications of the findings are unclear. Hanmer said from a physician's perspective, it could be a good thing. Transfers can be initiated to get a patient to a facility with specialized care or advanced therapies, or one that is closer to home with physicians who know the patients better.

“That said, I actually don’t know whether or not, at the end of the day, this is a good or bad thing for patients,” Hanmer said. “There’s always a risk when we do transfer that something bad will happen during the transfer. There’s always the risk of doing more interventions than we need to and putting people at risk from different procedures.”

For the study, data from the 2010 Nationwide Inpatient Sample was used. That’s the largest all-payer inpatient care database in the U.S. The five diagnoses examined were biliary tract disease, chest pain, pneumonia, sepsis and skin infection. The data covered 315,748 hospitalized patients, ages 18 to 64, who were discharged from 1,051 hospitals across the country.

Hanmer said the data gives a birds-eye view of hospital transfers, and since the patients’ care wasn’t tracked from hospital to hospital, there are some lingering questions about transfer trends.

“Is it that men or insured patients are requesting transfer more often to sort of initiate the process? Second, are the physicians doing something differently? Are they processing the requests from patients differently or are they thinking that transfer would be appropriate for different reasons? Or are they downplaying symptoms in uninsured patients or women?” Hanmer asked.

Hanmer said the study is cause for concern and finding warrant future investigation into the outcomes of transferred patients.

“If we presume that transfer between hospitals results in greater access to advanced treatments, then it’s evident that the uninsured and women face a serious health care disparity,” she said. “Alternatively, privately insured patients and men may be at risk of greater exposure to more costly procedures and excessive treatments.”

The study was done in collaboration with researchers from the University of Iowa and the University of Toronto and was funded by the Department of Veterans Affairs, the National Heart, Lung, and Blood Institute and the National Institutes of Health. It appeared this week in the Annals of Internal Medicine.