Insurance and inpatient care

Abstract

BACKGROUND: Early research demonstrated that patients' length-of-stay and inpatient costs varied according to their health insurance status. The authors of the current report studied a population-based sample of privately insured, Medicaid-insured, and uninsured inpatients ages 21 to 64 years who underwent surgical resection for either nonsmall cell lung cancer (NSCLC) (n ¼ 781) or colorectal cancer (CRC) (n ¼ 8190) or who underwent mastectomy (n ¼ 6201) to compare length of stay and inpatient costs by insurance status. METHODS: Data for this study were derived from all civilian, acute-care hospitals in Virginia from 1999 to 2005. Hierarchical generalized linear models were used to estimate the relation between the explanatory variables and lengths of stay and costs. All analyses controlled for patient characteristics and hospital random effects. RESULTS: Medicaid-insured patients with NSCLC had longer lengths of stay (39% or 2.64 days longer) and higher inpatient costs (20% or $2479 higher costs). Uninsured and Medicaidinsured patients with CRC had longer lengths of stay and higher inpatient costs. In contrast, uninsured patients with breast cancer had 11% shorter lengths of stay and 12% lower inpatient costs than privately insured patients. Medicaid-insured patients had 10% lower inpatient costs than privately insured patients. Differences were no longer statistically significant when reconstruction was added to the models. CONCLUSIONS: Health insurance affected the need for health care and the amount of health care received. Uninsured and Medicaid-insured patients with lung cancer and colon cancer who underwent resection had longer lengths of stay and higher inpatient costs than privately insured patients, but they had shorter lengths of stay when reconstruction was not provided. Among the patients with breast cancer, patients and/or providers economized on discretionary procedures. Cancer 2012;118:5084-91. V C 2012American Cancer Society.KEYWORDS: disparities, cancer, Medicaid, uninsured. INTRODUCTIONAs the United States grapples with medical care cost containment and simultaneously seeks ways to provide care for its estimated 52 million uninsured, 1 health care costs continue to rise, and disparities in health outcomes are widespread. Studies have tested the hypothesis that, in the absence of a third-party payer, hospitals and/or patients economize on unneeded procedures. Most of those studies have demonstrated that inpatient charges and lengths of stay are shortest for the uninsured followed by the Medicaid-insured relative to charges and lengths of stay for privately insured patients. [2][3][4][5] Nationwide, hospital stays are shorter for uninsured patients. 6 Such evidence is sometimes interpreted as support for the belief that hospitals offer services in response to financial incentives rather than services based solely on patient need. 7 Inpatient mortality often is greater for uninsured and Medicaid-insured patients relative to their privately insured counterparts, 4,5,8 suggesting that these patient...

Comparison of clinical outcomes between laparoscopic and open surgery for left-sided colon cancer: a nationwide population-based study

“…The main strength of this study is the use of a nationwide population-based dataset from Taiwan which launched a universal NHI program that covered more than 99% of its population. Therefore this study excluded the influence of insurance status which had been demonstrated to be an important confounding factor influencing the care of patients with colon cancer 27 . At the time of the sampling period, laparoscopic surgery for colon cancer has become a mature technique.…”

Comparison of clinical outcome between laparoscopic and open right hemicolectomy: a nationwide study

“…The main strength of this study is the usage of a nationwide population-based dataset from Taiwan which launched a universal NHI program at the end of 1995, and NHI program covered 98 % of Taiwan’s population. This study therefore excluded the influence of insurance status from our analysis which was demonstrated as an important factor influencing care of patients with colon cancer [ 34 ]. However, there are some limitations in this study.…”

Anticipating the Effects of Medicaid Expansion on Surgical Care

“…Previous national studies of Medicaid patients undergoing surgery have shown worse outcomes 2 and increased costs. 3 Given the ACA also mandates a reduction in payments to disproportionate share hospitals (DSH), 4 increased Medicaid enrollment could have substantial clinical and financial implications for hospitals facing expansion. To better understand this change, we examined the surgical outcomes and resource use of Medicaid patients in Michigan the year prior to implementation of the ACA using a statewide clinical registry.…”