Minority and low-income patients are disproportionately cared for by the country’s worst hospitals – those that have high costs and poor quality care – according to a new study that appears in the October issue of Health Affairs magazine.

The study, led by Ashish K. Jha from the Harvard School of Public Health, looked at 2007 data from the Department of Health and Human Services’ online Hospital Compare tool, the 2005 Medicare Provider Analysis and Review File, the 2007 American Hospital Association annual hospital survey, as well as other sources.

Out of the 3,229 hospitals surveyed, the study found that the nation’s 178 worst hospitals – the lowest-quality, highest-cost facilities – provided care for more than twice the number of minority and poor patients than the country’s 122 best institutions, where costs are lowest and quality the highest.

Perhaps unsurprisingly, low-quality hospitals also had higher mortality rates than high-quality hospitals.

At low-cost, low-quality hospitals, patients who were admitted with heart attacks or pneumonia were 12 to 19 percent more likely to die than similar patients admitted to the best hospitals. At high-cost, low-quality hospitals, heart attack and pneumonia patients were 7 to 10 percent more likely to die than patients with the same conditions at high-quality institutions.

On the other hand, the study found no meaningful difference in mortality rates and outcomes for patients with congestive heart failure at the worst hospitals compared to the best ones.

The worst hospitals, the study found, were smaller in size than the best hospitals, were mostly for-profit or public institutions, and tended to be located in the South. By contrast, the nation’s best hospitals were mostly nonprofit institutions located in the Northeast region and were often equipped with better technology, such as cardiac intensive care units.

Low-quality, high-cost hospitals saw a higher proportion of elderly Hispanic and black patients, according to the study. Elderly Hispanic and black patients accounted for 4 percent and 15 percent, respectively, of the patient base at the worst hospitals while they made up only 1 percent and 7 percent, respectively, of the total patients at the best hospitals.

The study also examined the characteristics of high-cost, high-quality hospitals. These institutions were more likely to be major teaching hospitals in urban areas with much higher nurse-to-patient ratios than other facilities. The high-cost, high-quality hospitals also earned much higher patient satisfaction ratings than other hospitals.

More nurses on staff could be a leading reason why patients reported having better experiences during their hospital stay, lead research Jha said. Higher costs at some hospitals could mean that they are spending extra money on things that their patients will value – like giving patients greater access to nurses when they need something.

While the best hospitals typically treated a higher proportion of Medicare patients, the worst hospitals treat a higher percentage of Medicaid patients, the study found. Of those hospitals, 23 percent of the patient base is made up of Medicaid patients compared to only 15 percent at higher-quality, low-cost facilities.

The study also warns about the implications for poorer and minority patients served by the worst hospitals under new Medicare payments arrangements schedules to take full effect in 2013. Under the new national value-based purchasing system, the federal government will give higher Medicare payments to high-quality, efficient hospitals that meet certain qualifications. At the same time, institutions that fail to meet these quality metrics or improve their quality of care will have their Medicare reimbursement payments cuts. 

"There are a lot of already disadvantaged hospitals that will not do well in this environment, and there will be significant consequences for their patients,” Jha said in a statement.