Hospitalization patterns of uninsured as base for services and health need assessment

Abstract

Background Solidarity is crucial for shifting from centralized to social health insurance model. Uninsured receive at least emergency and basic services free-of-charge. To which extent this policy really covers their health and services needs remains to be assessed. Methods DRGNational database (457 hospitals) was interrogated for continuous hospitalization of uninsured, 2014-2018. Use patterns were identified by episodes, LOS, diagnose, admission criterion. Avoidable admissions were assessed according to OECD criteria. Results Number of hospital episodes in uninsured varied annually, difference ranging from -13.5 to 6.3%; largest decrease in 2015 possibly due to day surgery implemented in 2014. About 2.5-3% of all episodes and hospitalization days were for uninsured. Use patterns identified: Most common admission criterion: Emergencies (95%) compared to Specific diagnosis&treatment, Births, Potentially endemic/epidemic diseases; Most frequent diagnosis: Emergency around birth,Mental disorders, Respiratory infections; Men 45 years old living in rural areas prevailed significantly; significant gender difference by age (9 years; t-test, p < 0.05); 3% of hospitalizations could be avoided by assistance in prehospital (asthma, COPD, CHF, Diabetes&utation). Conclusions The use patterns identified show inequity in access and gaps in policy meant to ensure solidarity in health. Day surgery was inittially beneficial in reducing financial burden, but addressing to prehospital health services continues to be low inducing overload of emergency units. A solution could be higher involvement of other sectors to ensure socio-economic security for all. Free-of-charge emergency hospital services ensure access for life threatening conditions but shortcut pre-hospital and postpone initial visits until non-preventable/-manageable stages. Key messages Reconsider services package to increase access for uninsured. Develop bridges between domains able to meet health related needs by intersectorial collaborations: labor, social, economic, health etc. Periodic analyze hospitalizations of uninsured, together with legal framework and sectoral policies to allow an appropriate decisions making and tailored intervention design.