Objective: To examine the association between patient race/ethnicity, insurance status, and their interaction with patient safety indicators among hospitalized patients.Methods: Cross-sectional study was conducted. Data were extracted from the 2009 National Inpatient Sample. A total of 3,052,268 patient safety indicator-related discharges were identified. Dependent variables were 11 patient safety indicators (PSI) whereas independent variables included race/ethnicity and insurance status. Results:As compared with White patients, African American patients were more likely to experience pressure ulcer, postoperative hemorrhage or hematoma, and post-operative pulmonary embolism (PE) or deep vein thrombosis (DVE); Asian/Pacific Islander patients were more likely to experience pressure ulcer, post-operative PE or DVT, and two obstetric care PSIs; whereas Hispanic/Latino patients were more likely to experience post-operative physiometabolic derangement and accidental puncture/ laceration. As compared with patients with private insurance, Medicaid patients were more likely to experience pressure ulcer, post-operative physiological metabolic derangement, post-operative PE or DVT, post-operative respiratory failure, post-operative wound dehiscence, and death among surgeries. However, both obstetric care PSIs showed that African Americans, Hispanics, and uninsured patients were less likely to incur them in comparison with their respective counterparts. Furthermore, strong interactive effects between African American and Medicaid on PSIs were detected. Conclusions:Although mixed findings in disparities in PSIs were observed in our study, Asian/Pacific Islander patients and Medicaid patients seem to be the most vulnerable. Further, interactive effects between African American and Medicaid indicate that poverty may be a key factor related to disparities in health care. Future research is merited to identify underlying factors that are related to PSIs among Asian/Pacific Islander patients. Strategies are needed to improve PSIs among Medicaid patients, especially during the current Medicaid program expansion due to the implementation of the Affordable Care Act.

This study examined the effect of state community benefit laws and guidelines on the community health orientation and the provision of hospital-based health promotion services in hospitals. The sample included all not-for-profit and investor-owned acute-care hospitals in the United States during the year 2000. Multiple regression procedures were used to test the effect of community benefit laws and type of ownership while controlling for organizational and environmental variables. The results of these procedures indicated that, on average, not-for-profit hospitals in the ten states with community benefit laws/guidelines reported significantly more community health orientation activities than did not-for-profit hospitals in the forty other states. The results of the multiple regression procedures also indicated that, on average, the investor-owned hospitals in the ten states with laws/guidelines reported significantly more community health orientation activities than did the investor-owned hospitals in the forty other states. The study found that community benefit laws had the effect of decreasing ownership-related differences in reported community health orientation activities. Further, Levene's test of equality of variance showed that the not-for-profit hospitals in community benefit states exhibited significantly lower variance in the community health orientation activities when compared with the not-for-profit hospitals in non-community benefit states. However, none of the statistical tests supported the hypotheses that community benefit laws compelled or induced hospitals to offer significantly more health promotion services. The study concluded that coercive measures such as community benefit laws were effective in compelling not-for-profit hospitals to report increased community orientation activities, and it also concluded that the mimetic pressures associated with these laws were effective in inducing investor-owned hospitals to report increased community orientation activities.

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BackgroundCompare changes in types of hospital service revenues between traditional Chinese medicine (TCM) hospitals and Western-medicine based general hospitals.Methods97 TCM hospitals and 103 general hospitals were surveyed in years of 2000 and 2004. Six types of medical service revenue between the two types of hospitals were compared overtime. The national statistics from 1999 to 2008 were also used as complementary evidence.ResultsFor TCM hospitals, the percentage of service revenue from Western medicine increased from 44.3% to 47.4% while the percentage of service revenue from TCM declined from 26.4% to 18.8% from 1999 to 2004. Percentages of revenue from laboratory tests and surgical procedures for both types of hospitals increased and the discrepancy between the two types of hospitals was narrowed from 1999 to 2004. For TCM hospitals, revenues from laboratory tests increased from 3.64% to 5.06% and revenues from surgical procedures increased from 3.44% to 7.02%. General hospitals' TCM drug revenue in outpatient care declined insignificantly from 5.26% to 3.87%, while the decline for the TCM hospitals was significant from 19.73% to 13.77%. The national statistics from 1999 to 2008 showed similar trends that the percentage of revenue from Western medicine for TCM hospitals increased from 59.6% in 1999 to 62.2% in 2003 and 66.1% in 2008 while the percentage of revenue from TCM for TCM hospitals decreased from 18.0% in 1999, 15.4% in 2003, and 13.7% in 2008.ConclusionWestern medicine has become a vital revenue source for TCM hospitals in the current Chinese health care environment where government subsidies to health care facilities have significantly declined. Policies need to encourage TCM hospitals to identify their own special and effective services, improve public perception, increase demand, strengthen financial sources, and ultimately make contributions to preserving one of the national treasures.