Electronic Theses and Dissertations

Date

2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Health Systems & Policy

Committee Chair

Satish Kedia

Committee Member

Angelia Sanders

Committee Member

Aram Dobalian

Committee Member

Meredith Ray

Abstract

Examining the Impact of Payer Type on Healthcare Outcomes in the United States Kiran Shankar Kamble, MBBS, MPH, Ph.D.(c) The University of Memphis. October 2024. Major Professor: Satish K. Kedia, PhD, MPH, MS Despite the evidence of disparities in healthcare outcomes by payer type, very little is known of how these disparities play out among healthcare institutions with similar resources or within levels of comorbidities and illness severity for the same gender. This research aims to fill this gap by examining healthcare disparities in three healthcare service delivery areas – emergency department (ED), inpatient, and readmissions. . Under study 1, to examine the impact of payer type on the outcomes of an ED visit diagnosed with pneumonia, using the Healthcare Cost and Utilization Project (HCUP) NEDS database, we identified 389,128 pneumonia cases diagnosed across 989 EDs in the US. The findings showed a significant impact of payer type on the outcomes of an ED visit diagnosed with pneumonia at each level of the CMI severity score and each level of the trauma centers. Patients on Medicare showed significantly higher odds of mortality than patients on Medicaid and private insurance. Under study 2, to examine the impact of payer type on the inpatient length of stay (LOS) for septicemia, using the HCUP NIS database, we identified 417,829 inpatient septicemia cases across 4,568 hospitals in the US. The findings showed a significant impact of payer type at each level of hospital ownership, patient sex, and CMI severity score. Patients on Medicaid showed longer LOS than those on Medicare and private insurance. Under study 3, to examine the impact of payer type on the probability of all-cause readmission for an index admission for AMI, using the HCUP NRD database, we identified 341,597 AMI cases with readmission across 2,507 hospitals in the US. The findings showed a significant impact of payer type at each level of teaching status, CMI severity scores, patient sex, and patient income. Patients on Medicare and Medicaid had higher odds of all-cause readmission than patients on private insurance. These findings will prompt health service researchers to further explore the root cause of such disparities and may also encourage policymakers and hospital administrators to develop relevant indicators to monitor and detect variations in the quality of care between payer types and prevent such disparities.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest.

Notes

Open Access

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