PDF(Pubmed)
Abstract：
BACKGROUND: Social risk factors are key drivers of the geographic variation in spending in the United States but little is known how community-level social risk factors are associated with hospital prices. Our objective was to describe the relationship between regional hospital-reported prices and social risk factors by price type (chargemaster, cash, commercial, Medicare, and Medicaid).
METHODS: This cross-sectional analysis used newly available hospital-reported prices from acute general hospitals in 2022. The prices were for 14 common services. Prices were winsorized at 98%, wage index-adjusted, standardized by service, and aggregated to hospital service areas (HSAs). For social risk, we used 23 measures across 5 domains of social risk (socioeconomic position; race, ethnicity, and culture; gender; social relationships; and residential and community context). Spearman\'s correlation was used to estimate associations between median prices and social risk by price type.
RESULTS: Prices were reported from 2,386 acute general hospitals in 45% (1,502 of 3,436) HSAs. Correlations between regional prices and other social risk factors varied by price type (range: -0.19 to 0.31). Chargemaster and cash prices were significantly correlated with the most community characteristics (10 of 23, 43%) followed by commercial prices (8, 35%). Medicare and Medicaid prices were only significantly correlated with 1 measure (all p < 0.01). All price types were significantly correlated with the percentage of uninsured (all p < 0.01). Chargemaster, cash, and commercial prices were positively correlated with percentage of Hispanic residents, residents with limited English proficiency, and non-citizens (all p < 0.05).
CONCLUSIONS: While regional correlations between prices and social risk factors were weak across all prices, chargemaster, cash, and commercial prices were more like closely aligned with community-level social risk factors than the two public payers (Medicare and Medicaid). Chargemaster, cash, and commercial hospital prices appeared to be higher in socially disadvantaged communities. Further research is needed to clarify the relationship between prices and community social risk factors.
METHODS: This cross-sectional analysis used newly available hospital-reported prices from acute general hospitals in 2022. The prices were for 14 common services. Prices were winsorized at 98%, wage index-adjusted, standardized by service, and aggregated to hospital service areas (HSAs). For social risk, we used 23 measures across 5 domains of social risk (socioeconomic position; race, ethnicity, and culture; gender; social relationships; and residential and community context). Spearman\'s correlation was used to estimate associations between median prices and social risk by price type.
RESULTS: Prices were reported from 2,386 acute general hospitals in 45% (1,502 of 3,436) HSAs. Correlations between regional prices and other social risk factors varied by price type (range: -0.19 to 0.31). Chargemaster and cash prices were significantly correlated with the most community characteristics (10 of 23, 43%) followed by commercial prices (8, 35%). Medicare and Medicaid prices were only significantly correlated with 1 measure (all p < 0.01). All price types were significantly correlated with the percentage of uninsured (all p < 0.01). Chargemaster, cash, and commercial prices were positively correlated with percentage of Hispanic residents, residents with limited English proficiency, and non-citizens (all p < 0.05).
CONCLUSIONS: While regional correlations between prices and social risk factors were weak across all prices, chargemaster, cash, and commercial prices were more like closely aligned with community-level social risk factors than the two public payers (Medicare and Medicaid). Chargemaster, cash, and commercial hospital prices appeared to be higher in socially disadvantaged communities. Further research is needed to clarify the relationship between prices and community social risk factors.
摘要：
背景：社会风险因素是美国支出地域差异的主要驱动因素，但鲜为人知的是社区层面的社会风险因素与医院价格的关系。我们的目标是按价格类型描述区域医院报告价格与社会风险因素之间的关系(chargemaster，cash,商业,Medicare,和医疗补助）。
方法：本横断面分析使用了2022年急诊综合医院最新提供的医院报告价格。价格为14项共同服务。价格为98%，工资指数调整后，按服务标准化，并汇总到医院服务区(HSA)。对于社会风险，我们在5个社会风险领域(社会经济地位；种族，种族,和文化；性别；社会关系；以及住宅和社区环境)。Spearman的相关性用于估计价格类型的中位数价格和社会风险之间的关联。
结果：报告了2,386家急性综合医院的价格，占45％（3,436个中的1,502个）HSA。区域价格与其他社会风险因素之间的相关性因价格类型而异（范围：-0.19至0.31）。Chargemaster和现金价格与大多数社区特征（23中的10，43％）显着相关，其次是商业价格（8，35％）。医疗保险和医疗补助价格仅与1项指标显着相关(所有p<0.01)。所有价格类型均与未投保百分比显着相关（均p<0.01）。主管,cash,商业价格与西班牙裔居民的百分比呈正相关，英语水平有限的居民，和非公民(所有p<0.05)。
结论：虽然价格和社会风险因素之间的区域相关性在所有价格中都很弱，chargemaster,cash,与两个公共付款人（Medicare和Medicaid）相比，商业价格更像是与社区层面的社会风险因素密切相关。主管,cash,在社会弱势社区，商业医院的价格似乎更高。需要进一步研究以阐明价格与社区社会风险因素之间的关系。
方法：本横断面分析使用了2022年急诊综合医院最新提供的医院报告价格。价格为14项共同服务。价格为98%，工资指数调整后，按服务标准化，并汇总到医院服务区(HSA)。对于社会风险，我们在5个社会风险领域(社会经济地位；种族，种族,和文化；性别；社会关系；以及住宅和社区环境)。Spearman的相关性用于估计价格类型的中位数价格和社会风险之间的关联。
结果：报告了2,386家急性综合医院的价格，占45％（3,436个中的1,502个）HSA。区域价格与其他社会风险因素之间的相关性因价格类型而异（范围：-0.19至0.31）。Chargemaster和现金价格与大多数社区特征（23中的10，43％）显着相关，其次是商业价格（8，35％）。医疗保险和医疗补助价格仅与1项指标显着相关(所有p<0.01)。所有价格类型均与未投保百分比显着相关（均p<0.01）。主管,cash,商业价格与西班牙裔居民的百分比呈正相关，英语水平有限的居民，和非公民(所有p<0.05)。
结论：虽然价格和社会风险因素之间的区域相关性在所有价格中都很弱，chargemaster,cash,与两个公共付款人（Medicare和Medicaid）相比，商业价格更像是与社区层面的社会风险因素密切相关。主管,cash,在社会弱势社区，商业医院的价格似乎更高。需要进一步研究以阐明价格与社区社会风险因素之间的关系。
