Impact of Minority Presence and Hospital Reimbursement Policy on Referral Region Health Rankings

Abstract

The shift from a fee-for-service payment to a value-based payment scheme, sparked by the Patient Protection and Affordable Care Act (ACA), introduced pay-for-performance programs such Hospital Value Based Purchasing (HVBP). Recent research has focused on the effectiveness of these new health policy initiatives on hospital systems and the associated influence on reducing cost and improving patient care. However, previous inquiry has not considered how local community factors may affect hospital system performance. As a result, this study investigated the association between local health performance and minority population in a Hospital Referral Region (HRR). The primary objective was to ascertain whether community diversity levels are significantly associated to local health performance guided by the Ecological model. Data was collected from the 2016 American Hospital Association dataset, Area Health Resource File dataset, Commonwealth Fund Scorecard on Local Health System Performance and the Dartmouth Atlas Hospital Referral Region dataset. Multiple regression analysis was used to compare ethnic groups, population characteristics and hospital performance (measured by value-based purchasing total performance scores (TPS)) across 304 HRRs. Our primary findings show that the more diverse a HRR is the more likely it is to be associated with lower ranking for Access and Affordability Prevention and Treatment Avoidable Hospital Use and Cost as well as Healthy Lives. TPS was significantly related to a better health ranking on Prevention and Treatment, Hospital Use and Cost, as well as Healthy Lives. This research supports the assertion that communities, particularly minorities in those communities, affect local healthcare performance in a variety of ways. Even with advancement in medical care and payment reform, health disparities persist between different racial and ethnic populations and health equity remains elusive.