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Rapid response to:


Access, quality, and costs of care at physician owned hospitals in the United States: observational study

BMJ 2015; 351 doi: (Published 02 September 2015) Cite this as: BMJ 2015;351:h4466

Rapid Response:

Access cannot be addressed without considering social determinants of health

I would like to commend Dr. Blumenthal et al. on their research on the access, quality and costs disparities that exist between physician owned hospitals (PHOs) and non-PHOs. The authors have, however, overlooked a few very important aspect in carrying out their research. Namely, they have failed to address how the establishment of PHOs, especially specialty PHOs, in non-urban areas restricts access to those facilities for minority and poor populations.

While it may be argued that PHOs are not actually pushing away minority and poor patients, by failing to establish PHOs in urban areas which serves these population, PHOs are implicitly making a stance that the minority and poor population is not their desired population. The social determinants of health are those personal, social, economic, and environmental factors that play a major role in an individual’s health outcomes. Such factors are vitally important in determining health equity. The research conducted by Blumenthal et al. does not address how the absence of PHOs in minority or poor neighbors impacts the overall health of the community. Even in the information that states that the minority populations that are served by non-PHOs and PHOs are similar, the authors fail to explore the socioeconomic status of those minorities, which may have made a difference in their ability to access PHO services. Equally interesting and concerning is that while the authors compare non-PHOs to general PHOs, and PHOs to specialty PHOs, they fail to compare non-PHOs to specialty PHOs.

In summary, the authors’ research is to be commended, however, any research into access and quality disparities is incomplete without considering that role of social determinants of health.
Best regards,

Mario D. Ramsey, JD, MPH
Satcher Health Leadership Fellow,
Morehouse School of Medicine

Competing interests: No competing interests

20 October 2015
Mario D Ramsey
Satcher Health Leadership Fellow
Morehouse School of Medicine
Atlanta, GA 30310