Patient cost-sharing and insurance arrangements are associated with hospital readmissions after abdominal surgery: Implications for access and quality health care

Surgery. 2016 Mar;159(3):919-29. doi: 10.1016/j.surg.2015.09.007. Epub 2015 Oct 23.


Background: Readmission rates after operative procedures are used increasingly as a measure of hospital care quality. Patient access to care may influence readmission rates. The objective of this study was to determine the relationship between patient cost-sharing, insurance arrangements, and the risk of postoperative readmissions.

Methods: Using the MarketScan Research Database (n = 121,002), we examined privately insured, nonelderly patients who underwent abdominal surgery in 2010. The main outcome measures were risk-adjusted unplanned readmissions within 7 days and 30 days of discharge. Odds of readmissions were compared with multivariable logistic regression models.

Results: In adjusted models, $1,284 increase in patient out-of-pocket payments during index admission (a difference of one standard deviation) was associated with 19% decrease in the odds of 7-day readmission (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.78-0.85) and 17% decrease in the odds of 30-day readmission (OR 0.83, 95% CI 0.81-0.86). Patients in the noncapitated point-of-service plans (OR 1.19, 95% CI 1.07-1.33), preferred provider organization plans (OR 1.11, 95% CI 1.03-1.19), and high-deductible plans (OR 1.12, 95% CI 1.00-1.26) were more likely to be readmitted within 30 days compared with patients in the capitated health maintenance organization and point-of-service plans.

Conclusion: Among privately insured, nonelderly patients, increased patient cost-sharing was associated with lower odds of 7-day and 30-day readmission after abdominal surgery. Insurance arrangements also were significantly associated with postoperative readmissions. Patient cost sharing and insurance arrangements need consideration in the provision of equitable access for quality care.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cohort Studies
  • Confidence Intervals
  • Cost Sharing / economics*
  • Databases, Factual
  • Digestive System Surgical Procedures / adverse effects
  • Digestive System Surgical Procedures / economics*
  • Digestive System Surgical Procedures / methods
  • Female
  • Health Care Costs
  • Health Maintenance Organizations / economics
  • Humans
  • Infant
  • Insurance, Health / economics*
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Readmission / economics*
  • Patient Readmission / statistics & numerical data
  • Point-of-Care Systems / economics
  • Quality of Health Care*
  • United States
  • Young Adult