Non-medical factors, including a patient's gender and insurance status, may influence care decisions and lead to potential health disparities, suggests an article published in Annals of Internal Medicine.

Federal law mandates that hospitals and physicians treat patients in need of emergency medical care regardless of race, ethnicity, sex, or ability to pay. Concerns persist that patients are transferred between hospitals for nonmedical reasons, but existing data are limited with virtually all studies focusing on the prehospital or emergency department settings. Researchers reviewed inpatient care data for 315,748 patients between the ages of 18 and 64 to examine the relationship between patients' insurance coverage and interhospital transfers for five common medical diagnoses: biliary tract disease, chest pain, pneumonia, sepsis and skin infection. The researchers found that uninsured hospitalized patients were significantly less likely to be transferred to another hospital for four of the five diagnoses when compared with privately insured patients, even after adjusting for demographic factors and severity of illness.

Women were 35 to 40 percent less likely to be transferred than men for all five diagnoses. The researchers write that they were surprised by these findings but suspect that the lower transfer rate may be due to hospitals' unwillingness to accept uninsured patients when a transfer is requested. The authors write that more research is needed to understand why providers were also less likely to transfer women, but they suspect that physicians may take symptoms in women less seriously than they do in men.