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. 2020 Jan 3;3(1):e1920053.
doi: 10.1001/jamanetworkopen.2019.20053.

Market Share of US Catholic Hospitals and Associated Geographic Network Access to Reproductive Health Services

Coleman Drake  1 , Marian Jarlenski  1 , Yuehan Zhang  2 , Daniel Polsky  2
Affiliations

Market Share of US Catholic Hospitals and Associated Geographic Network Access to Reproductive Health Services

Coleman Drake et al. JAMA Netw Open. .

Abstract

Importance: Access to reproductive health services is a public health goal. It is unknown how geographic and health plan network availability of Catholic and non-Catholic hospitals may be associated with access to reproductive health services in the United States.

Objective: To characterize the market share of Catholic hospitals in the United States, both overall and within Marketplace health insurance plans' hospital networks.

Design, setting, and participants: This cross-sectional study of US counties used data on hospitals' Catholic affiliation and discharges, hospital networks in Marketplace health insurance plans, and US Census population data to construct a national, county-level data set. The Catholic hospital market share overall in each county and in Marketplace plans' hospital networks in each county were calculated. The study examined whether the Catholic hospital market share was different within Marketplace networks compared with the counties they served. Data analysis was conducted in May and June 2018.

Main outcomes and measures: The overall Catholic hospital market share was calculated on the basis of the share of discharges in Catholic hospitals in a county compared with all hospital discharges. Overall market share was categorized as minimal (≤2%), low (>2% to ≤20%), high (>20% to ≤70%), or dominant (>70%). The Catholic hospital market share in Marketplace networks was calculated as the share of Catholic hospital discharges in each Marketplace network.

Results: The sample included 4450 hospitals in 3101 counties. Overall, 26.1% of US counties had minimal Catholic hospital market share, 38.6% had low Catholic hospital market share, and 35.3% had high or dominant Catholic hospital market share; 38.7% of US reproductive-aged women resided in counties with high or dominant Catholic hospital market share. Among counties with Catholic hospital market share greater than 2%, the distribution of the median Marketplace network's Catholic hospital market share (median [interquartile range], 4.6% [0%-24.3%]) was lower than overall Catholic hospital market share (median [interquartile range], 18.5% [8.1%-36.5%]). The median Marketplace hospital network had a lower Catholic hospital market share than the county overall in 68.0% of US counties with Catholic hospital market share greater than 2%.

Conclusions and relevance: In this national study, 35.3% of counties had high or dominant Catholic hospital market share serving an estimated 38.7% of US women of reproductive age. Marketplace health insurance plans' hospital networks included a lower share of Catholic hospitals than the counties they serve.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Polsky reported receiving grants from the Robert Wood Johnson Foundation, Arnold Ventures, and the National Institutes of Health outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Catholic Hospital Market Share of US Counties
Map shows the overall Catholic hospital market shares in all continental US counties. Counties are shown by their Catholic hospital market shares (minimal, low, high, or dominant).
Figure 2.
Figure 2.. Distributions of Catholic Hospital Market Shares Within Marketplace Networks by Catholic Hospital Market Share
The distribution of the median Marketplace network’s Catholic hospital market share (median [interquartile range {IQR}], 4.6% [0%-24.3%]) is lower than the overall Catholic hospital market share (median [IQR], 18.5% [8.1%-36.5%]). The median (IQR) market share for the least Catholic network is 0.0% (0.0%-1.9%) and that for the most Catholic network is 30.3% (6.5%-67.1%). The figure excludes 820 counties with minimal (≤2%) market share of Catholic hospitals or counties where available Marketplace networks did not accurately represent the Marketplace. Lines within boxes show medians, tops and bottoms of boxes show 75th and 25th percentiles, respectively, and error bars show 95% CIs.
Figure 3.
Figure 3.. Counties Where Marketplace Networks Provide Greater Access to Reproductive Health Services
Map shows counties according to access to reproductive services and whether their least (A), median (B), and most (C) Catholic Marketplace networks have lower Catholic market shares than their respective counties overall.
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Comment in

  • doi: 10.1001/jamanetworkopen.2019.20131

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