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Addressing Medicaid Expansion from the Perspective of Patient Experience in Hospitals

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Abstract

Background

More Medicaid holders are entering the healthcare system consequential to Medicaid expansion. Their experience has financial consequences for hospitals and crucial implications for the provision of patient-centered care. This study examined how the hospital characteristics, especially the rates of Medicaid coverage and racial/ethnic minorities, impact the quality of inpatient care.

Methods

Using data for years 2009–2011 for 870 observations of California hospitals, and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems survey coupled with data from the Healthcare Cost and Utilization Project and American Hospital Association Annual Survey, we used a generalized estimating equation approach to evaluate patients’ experience with hospital care. Our multivariate model includes a comprehensive set of characteristics capturing market, structural, process, and patient demographics associated with the patient’s hospital stay.

Results

The findings indicate that high concentrations of Medicaid patients in the hospital negatively impact the perceived patient experience. In addition, all things being equal, hospitals with higher concentrations of Hispanic, Black, and Asian patients received lower patient satisfaction results on 28 of the 30 regression coefficients capturing patient satisfaction, with 22 of the 30 negative coefficients statistically significant.

Conclusions

Hospitals serving higher concentrations of Medicaid patients and more racial/ethnic diverse patients experienced a less satisfactory patient experience than patients utilizing other payers or patients who were White. Our research magnifies the challenge for addressing the disparities that exist in healthcare. Further research is called for clarifying the underlying reasons for these disparities and the optimal strategies for addressing these problems.

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Author contributions

Sandra Liu developed the conceptual framework, coordinated the study, reviewed relevant literatures, and drafted and revised the manuscript; Yu-Ping Wen conducted the data analyses, reviewed relevant literatures, and drafted the manuscript; Soumya Mohan reviewed the relevant literatures, and drafted the manuscript; Jaeyong Bae compiled the data and revised the manuscript; and Edmund R. Becker developed the conceptual framework, coordinated the study, reviewed the relevant literatures, and revised the manuscript.

Author information

Authors and Affiliations

  1. College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA

    Sandra S. Liu & Soumya Mohan

  2. College of Management, Chang Gung University, 259 Wen-Hua 1st Road, Kwei-Shan, Taoyuan, 333, Taiwan

    Yu-Ping Wen

  3. Nursing and Health Studies, Northern Illinois University, DeKalb, IL, USA

    Jaeyong Bae

  4. Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Edmund R. Becker

Authors
  1. Sandra S. Liu
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Corresponding author

Correspondence to Yu-Ping Wen.

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Conflict of interest

Sandra S. Liu, Yu-Ping Wen, Soumya Mohan, Jaeyong Bae, and Edmund R. Becker declare that they have no conflicts of interest.

Funding

This research was supported by a Patient-Centered Outcomes Research Institute (PCORI) Pilot Project Program Award (1IP2PI000167-01). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the PCORI, its board of governors, or its Methodology Committee (http://www.pcori.org/research-results/2012/patient-centered-care-what-factors-drive-outcomes-hospital-setting).

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Liu, S.S., Wen, YP., Mohan, S. et al. Addressing Medicaid Expansion from the Perspective of Patient Experience in Hospitals. Patient 9, 445–455 (2016). https://doi.org/10.1007/s40271-016-0167-y

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