"Patients of the lowest socioeconomic status were significantly less likely to use an ASC than patients of higher status," write the authors of a study published online this week in BMC Health Services Research. "Given the improved efficiencies of ASCs over hospital outpatient departments, patients could be expected to abandon hospital-based outpatient surgery. However, such a trend has not developed [for everyone]."
The study, conducted by a group of researchers at the University of Michigan, found that 60% of patients in the lowest socioeconomic group (median household income of $29,621) used ASCs, compared to 65% of those in the highest group (median household income of $55,292). The group in the middle (median household income of $37,972) was the most frequent users of ASCs. For Hispanics, the trend was the opposite: The higher the socioeconomic status, the more likely the patient was to have a day surgery procedure done in a hospital.
"In marketing ASCs, the lower use in patients of lower socioeconomic status needs to be recognized," says Seth A. Strope, MD, MPH, lead author and clinical lecturer in the urology department of the University of Michigan Health System. "The vast majority of these patients are privately insured, or have Medicare, and would benefit from the lower cost environment of the ASC."
The disparity between social classes may be a result of "patient profiling," say the study authors. "Physicians will often recommend different procedures for the same clinical situation when the race or gender of the patient is changed," they write. The same goes for economic status and the quality of the patient’s health insurance. "Since most ASCs are for-profit enterprises with significant physician ownership, physicians have active incentives to ensure high reimbursement through these facilities."
Another reason may be that fewer surgery centers open near neighborhoods with less wealthy residents, the authors suggest. "The benefits of ASCs in cost, convenience and efficiency are not equally distributed."
The analysis was based on data from 43% of all ambulatory procedures performed in Florida in 2005. Dr. Strope says that Florida is a unique healthcare market, in part because the state has no certificate of need requirements. "However, since the facilities are easily established with minimal regulatory hurdles to creation, the usage patterns we see in Florida may be representative of other such healthcare markets."
—Kent Steinriede
