Li Z; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2001; 18: 86.
Texas Health Care Information Council, 206 East 9th Street, Suite 19.140, Austin, Texas 78701, Phone: (512) 482-3324, Fax: (512) 453-2757, E-mail: zhongmin.li@thcic.state.tx.us
RESEARCH OBJECTIVE: Recent release of Texas Hospital Discharge data makes it possible to conduct statewide research on uninsured inpatients. This paper is among the first to examine demographic, diagnostic and treatment patterns of uninsured inpatients in Texas.STUDY DESIGN: This study uses Texas hospital discharge data for patients discharged from over 400 state licensed hospitals between January and June 1999. The data are collected and maintained by the Texas Health Care Information Council as mandated by state legislation. The data include demographic and diagnoses/procedures information for 1.2 million inpatients from all payers sources (including self-pay and charity) and discharged during the reference period. This study examines (1) the demographic characteristics of uninsured inpatients and (2) the treatment and outcome (in term of length of stay, stay length adjusted total charge and in-hospital mortality) of the most frequent admitting conditions of uninsured inpatients in comparison to the insured inpatient population.POPULATION STUDIED: All inpatients, excluding those transferred to another hospital or who left against medical advice, with primary payment sources identified as either self-pay or paid by charity at the time of discharge.PRINCIPAL FINDINGS: (1) 10 percent of total discharged inpatients in Texas hospitals during the first six months of 1999 do not have any type of insurance. 46.5 percent of the uninsured are in the age group of 18-44 and 55 percent of the uninsured are female. While 7.5 percent of white inpatients are uninsured, nearly 15 percent of Hispanic and American Indian inpatients have no insurance. Uninsured patients are more likely from metropolitan areas. (2) Excluding obstetric and newborns, mental disorder, circulatory diseases and respiratory conditions are among the most frequently reasons for hospitalization. While 26 percent of mental disorder patients have no insurance, the rate was 29 percent for HIV patients and 33 percent for drug and alcohol use patients. (3) Controlling for diagnose and patient age, the average length of stay of insured mental disorder patients is 215 percent longer than uninsured and the total charges per day for insured is 46 percent higher than uninsured. For pneumonia, asthma and bronchiolitis, heart failure, chest pain, uterine and adnexa procedure for ca in situ and nonmalignancy, and poisoning and toxic effect of drug (APRDRG 139, 141,194,203, 513, 812), the average length of stay for insured is 31 percent longer than uninsured and total charges per day for insured patients is 9.2 percent higher than uninsured. (4) Controlling for patient age, the insurance status of patient have no association with in-hospital mortality for intracranial hemorrhage, CVA with infarction, pneumonia, coronary bypass, and heart failure (p-values >0.05).CONCLUSIONS: The findings suggest that: (1) uninsured patients have distinctive demographic and diagnostic patterns; (2) Controlling for patient age and diagnoses insurance status of inpatients has a significant impact on length of stay and total charges but not on inhospital mortality.IMPLICATIONS FOR POLICY, DELIVERY, OR PRACTICE: This study suggests that greater efforts are needed to enroll uninsured patients and to provide equal quality health care for uninsured and insured patients. The fact that insured and uninsured patients experienced different charges may call for further investigation.PRIMARY FUNDING SOURCE: Texas Health Care Information Council
Publication Types:
Keywords:
- Demography
- European Continental Ancestry Group
- Fees and Charges
- Female
- Hispanic Americans
- Humans
- Infant, Newborn
- Insurance Coverage
- Insurance, Health
- Length of Stay
- Medically Uninsured
- Patient Discharge
- Texas
- economics
- hsrmtgs
Other ID:
UI: 102273319
From Meeting Abstracts