Inpatient Hospital Utilization among the Uninsured Near Elderly: Data and Policy Implications for West Virginia

DiNitto

2020

IJERPH

Lack of health insurance (HI) is a particular problem for near-older Americans aged 50-64 because they tend to have more chronic health conditions than younger age groups and are at increased risk of disability; however, little recent research has focused on HI coverage and healthcare access among this age group. Using the U.S. National Health Interview Survey data for the years 2013 to 2018, we compared HI coverage and healthcare access between the 50-64 and 65+ age groups. Using logistic regression analysis, we then examined the sociodemographic and health characteristics of past-year healthcare access of near-older Americans without HI to those with private HI or public HI (Medicare without Medicaid, Medicaid without Medicare, Medicare and Medicaid, and VA/military HI). We estimated the odds of healthcare access among those without HI compared to those with private or public HI. Near-older Americans without HI were at least seven times more likely to have postponed or foregone needed healthcare due to costs, and only 15% to 23% as likely to have had contact with any healthcare professional in the preceding 12 months. Expanding HI to near-older adults would increase healthcare access and likely result in reduced morbidity and mortality and higher quality of life for them.

Section: Discussionmentioning

confidence: 99%

Unmet Healthcare Needs and Healthcare Access Gaps Among Uninsured U.S. Adults Aged 50–64

DiNitto

2020

IJERPH

“…7,8 The prevalence of multiple risk factors for heart disease and stroke is highest among people with the lowest household incomes (52.5%), and almost twice as high as the prevalence of those with the highest household income (28.8%). 9 Individuals who are uninsured are substantially more likely to be hospitalized for a preventable condition, 10,11 or to be diagnosed with a later-stage cancer. 12,13 Regardless of income level, lack of health insurance is associated with decreased use of recommended health care services for cancer prevention, cardiovascular risk reduction, and diabetes management.…”

Section: The Problemmentioning

confidence: 99%

Paths to Success: Optimal and Equitable Health Outcomes for All

Rust¹,

Levine²,

Fry-Johnson³

et al. 2012

hpu

U.S. health disparities are real, pervasive, and persistent, despite dramatic improvements in civil rights and economic opportunity for racial and ethnic minority and lower socioeconomic groups in the United States. Change is possible, however. Disparities vary widely from one community to another, suggesting that they are not inevitable. Some communities even show paradoxically good outcomes and relative health equity despite significant social inequities. A few communities have even improved from high disparities to more equitable and optimal health outcomes. These positive-deviance communities show that disparities can be overcome and that health equity is achievable. Research must shift from defining the problem (including causes and risk factors) to testing effective interventions, informed by the natural experiments of what has worked in communities that are already moving toward health equity. At the local level, we need multi-dimensional interventions designed in partnership with communities and continuously improved by rapid-cycle surveillance feedback loops of community-level disparities metrics. Similarly coordinated strategies are needed at state and national levels to take success to scale. We propose ten specific steps to follow on a health equity path toward optimal and equitable health outcomes for all Americans.

“…25 Reasons for expeditious placement are likely related to delayed healthcare access in rural settings resulting in greater illness severity upon presentation. 26-33 Barriers to healthcare access and greater co-morbidity burden may also explain why the uninsured were more likely to require emergent CVC during their hospital visit. 31-33 Irrespective of the exact causes, populations traditionally challenged by access to the healthcare system may be more likely to require early CVC placement.…”

Section: Discussionmentioning

confidence: 99%

Rates and Timing of Central Venous Cannulation Among Patients With Sepsis and Respiratory Arrest Admitted by the Emergency Department*

Theodoro

Owens

Olsen

et al. 2014

Critical Care Medicine

Objective Clinical guidelines for the acute management of emergency department (ED) patients with severe sepsis encourage the placement of central venous catheters (CVC). Data examining the timing of CVC insertion among critically ill patients admitted from the ED are limited. We examined the hypothesis that prompt CVC insertion during hospitalization among patients admitted from the ED acts as a surrogate marker for early aggressive care in the management of critically ill patients. Design Retrospective cross sectional analysis of ED visits using 2003-2006 discharge data from California, State Inpatient Databases (SID), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Setting General medical or general surgical hospitals (n=310). Patients Patient hospitalizations beginning in the ED with the two most common diagnoses associated with CVC (sepsis and respiratory arrest.) Interventions None. Measurements and Main Results We identified the occurrence and timing of CVC using International Classification of Diseases, Clinical Modifications, 9th Revision procedure codes. The primary outcomes measured were annual CVCs per 1000 hospitalizations that began in the ED occurring emergently (procedure day 0), urgently (procedure day 1-2), or late (procedure day 3 or later). A total of 129,288 hospital discharges had evidence of CVC. In 2003 5,759 CVCs were placed emergently compared to 10,469 in 2006. The rate of emergent CVC/1000 increased annually from 228 in 2003, 239 in 2004, 257 in 2005, up to 269 in 2006. Urgent and late CVC rates trended down (p<.001). In a multilevel model the odds of undergoing emergent CVC relative to 2003 increased annually: 1.08 (95%CI, 1.03 to 1.12) in 2004, 1.19 (95%CI, 1.14 to 1.23) in 2005, and 1.28 (95%CI, 1.23 to 1.33) in 2006. Conclusions CVCs are inserted earlier and more frequently among critically ill patients admitted from the ED. Earlier CVC insertion may require systematic changes to meet increasing utilization and enhanced mechanisms to measure CVC outcomes.