Hospital ownership and admission rates from the emergency department, evidence from Florida

Abstract

AbstractObjectiveIn light of Department of Justice investigations of for‐profit chains for over‐admitting patients, we sought to evaluate whether for‐profit hospitals are more likely to admit patients from the emergency department.Data SourcesWe used statewide visit‐level inpatient and emergency department records from Florida's Agency for Healthcare Administration for 2007–2019.Study DesignWe calculated differences in admission rates between for‐profit and other hospitals, adjusting for patient and hospital characteristics. We also estimated instrumental variables models using differential distance to a for‐profit hospital as an instrument.Data Collection/Extraction MethodsOur main analysis focuses on patients ages 65 and older treated in hospitals that primarily serve adults.Principal FindingsAdjusted admission rates among patients ages 65 and older were 7.1 percentage points (95% CI: 5.1–9.1) higher at for‐profit hospitals in 2019 (or 18.8% of the sample mean of 37.8%). Differences in admission rates have remained constant since 2009.ConclusionOur results are consistent with allegations that for‐profit hospitals maintain lower admission thresholds to increase occupancy levels.