The impacts of the 340B Program on health care quality for low-income patients

Abstract

Objective: To assess the effects of hospital 340B eligibility on quality of inpatient care provided to Medicaid and uninsured patients and for all patients.

Data: Agency for Health Care Research and Quality's Healthcare Cost and Utilization Project State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and American Hospital Association Annual Survey.

Design: Regression discontinuity design comparing hospitals just above the DSH percentage program eligibility threshold to those just below. Quality measures include all-cause mortality and 30-day readmission rates as well as condition-specific measures.

Data extraction: Inpatient data from general acute care hospitals from 2008 to 2014 in 15 states. Data linked on hospital 340B eligibility and participation.

Principal findings: We did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality (beta = -0.04 percentage points, 95% CI: -0.16, 0.08), 30-day readmission rates (beta = -0.16 percentage points, 95% CI: -0.81, 0.5), or other measures. Among insured and non-Medicaid patients, we found discontinuities for acute myocardial infarction (beta = -0.87 percentage points, 95% CI: -1.55, -0.2) and postoperative sepsis (beta = -0.15 percentage points, 95% CI: -0.23, -0.07) mortality.

Conclusions: 340B Program participation has not demonstrated improved quality of inpatient care among Medicaid or uninsured patients.

Keywords: 340B; DSH hospitals; safety net care.

FIGURE 1

340B Program‐related discontinuities in hospital‐level quality outcomes for Medicaid and uninsured patients and all patients. The yearly rate of each outcome is plotted against the disproportionate share hospital (DSH) adjustment percentage in the previous year, which determines 340B Program eligibility. Outcomes among Medicaid and uninsured patients are pooled and plotted separately from outcomes among all patients. Hospitals were grouped into one‐percentage‐point bins based on their DSH percentage values, and unadjusted means within each bin were calculated and plotted. A linear fit with a 95% confidence interval of the underlying hospital‐year‐level data is plotted on either side of the eligibility threshold. The vertical line marks the threshold for eligibility for the 340B Program at a DSH percentage of 11.75%.