Dr. Sharma rightly points out that the ability of our analysis to isolate the effects
of race/ethnicity, insurance status, Spanish as a primary language, and safety-net
vs private hospital setting are limited due to the collinearity of these factors in
our patient population. Framing the issue another way, our safety-net facility is
simultaneously a public hospital, a safety-net hospital, and a minority-serving hospital;
and each of these factors likely contributes in varying degrees to an individual patient's
outcomes. We do recognize that our study population reflects the unique circumstances
of North Texas, with a high proportion of young and Hispanic patients and what amounts
to a socialized indigent health care system (ie the government is both the payor and
provider of care for the uninsured). Population and policy differences will likely
lead to variations in different parts of the country and between rural and urban areas.
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References
- Changes in hospitalizations at US safety-net hospitals following medicaid expansion.JAMA Netw Open. 2021; 4e2114343https://doi.org/10.1001/jamanetworkopen.2021.14343
- Medicare program associated with narrowing hospital readmission disparities between black and white patients.Health Aff. 2018; 37: 654-661https://doi.org/10.1377/hlthaff.2017.1034
Kaiser Family Foundation. Uninsured rates for the nonelderly by race/ethnicity. Available at: https://www.kff.org/uninsured/state-indicator/nonelderly-uninsured-rate-by-raceethnicity. Accessed July 24, 2021.
Article info
Publication history
Accepted:
May 3,
2021
Received:
February 9,
2021
Identification
Copyright
© 2021 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.