DSH payments disproportionately disadvantage Black patients
Racial and ethnic minority groups often have lower levels of use, meaning hospitals in largely Black counties are at a disadvantage.
Photo: FG Trade/Getty Images
The Disproportionate Share Hospital (DSH) program, run by the Centers for Medicare and Medicaid Services, is meant to subsidize care for low-income patients, but is falling short when it comes to supporting hospitals in traditionally disadvantaged Black communities, according to new findings published in JAMA Network Open.
Medicare and Medicaid DSH payment programs allocate $24 billion to hospitals annually to subsidize care and improve outcomes for low-income patients. DSH allocations are based largely on measures of patient characteristics that reflect healthcare use for low-income patients, such as the proportion of inpatients enrolled in Medicaid.
But since racial and ethnic minority groups face sizable structural barriers to healthcare, they often have lower levels of use than non-minoritized racial and ethnic groups, conditional on having the same level of healthcare need.
Because DSH funding is partially allocated based on measures of healthcare use, the hypothesis posed by researchers was that hospitals in disproportionately Black counties received payments that failed to meet their financial needs and the needs of the populations they served.
WHAT'S THE IMPACT?
Counties with the largest proportions of Black residents received a mean of $9 per resident in Medicare DSH payments and $52 per resident in Medicaid DSH payments, relative to other counties, which received a mean of $4 per resident in Medicare DSH payments and $20 per resident in Medicaid DSH payments.
Disproportionately Black counties that received the same level of funding as other counties demonstrated higher rates of uncompensated care and health-related disadvantage, findings showed.
Holding Medicare DSH payments per resident constant, counties with the largest proportions of Black residents relative to other counties had significantly higher rates of uncompensated hospital care, percentage of uninsured residents, premature mortality and percentage of residents reporting poor or fair health.
Similar results were evident when Medicaid DSH payments were held constant, data showed.
These findings suggest that DSH programs, by relying on measures of patient characteristics that reflect healthcare use, may structurally disadvantage communities that most require resources to improve population health.
Authors said that even though they didn't evaluate non-DSH supplemental payments, the findings suggest that policymakers should consider measures that aren't based on healthcare use to ensure more equitable targeting of DSH payments, or additional allocations to underserved communities.
THE LARGER TREND
The federal government is making a push to address racial and ethnic disparities, with a focus as of late on maternal health outcomes. In late August, the Department of Health and Human Services, through the Health Resources and Services Administration, announced investments of more than $20 million to reduce disparities in maternal and birth outcomes.
The funding will help expand and diversify the workforce caring for pregnant and postpartum individuals, increase access to obstetrics care in rural communities and support states in tackling inequities in maternal and infant health.
Black women are three times more likely to die from a pregnancy-related cause in this country than white women, according to HRSA Administrator Carole Johnson.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
