Differences in hospital resource allocation among sick newborns according to insurance coverage.
OBJECTIVE
To assess whether newborns' insurance coverage was associated with differences in the allocation of hospital services.


METHODS
Retrospective analysis of computerized hospital discharge data, comparing resource allocation among newborns according to insurance status, controlling for race/ethnicity, diagnoses, hospital characteristics (ownership, teaching status, nursery level), and disposition.


METHODS
All California civilian acute-care hospitals.


METHODS
Population-based sample, excluding out-of-hospital and military hospital births. Resource allocation was studied among all newborns discharged in 1987 with evidence of serious problems (N = 29,751).


METHODS
Length of stay, total charges, and charges per day.


RESULTS
Sick newborns without insurance received fewer inpatient services than comparable privately insured newborns with either indemnity or prepaid coverage. This pattern was observed across all hospital ownership types. Mean stay was 15.7 days for all privately insured newborns (15.6 days for those with indemnity and 15.7 days for those with prepaid coverage), 14.8 days for Medicaid-covered newborns, and 13.2 days for uninsured newborns (P less than .001). Length of stay, total charges, and charges per day were 16%, 28%, and 10% less, respectively, for the uninsured than for all privately insured newborns (P less than .001). Resources for newborns covered by Medicaid were generally greater than for the uninsured and less than for the privately insured. Both uninsured and Medicaid-covered newborns were found to have more severe medical problems than the privately insured.


CONCLUSIONS
The findings cannot be explained by differences in medical need or by differences in non-medically indicated services; they constitute prima facie evidence of inequities that need to be addressed by policy changes.
Braveman
P A
PA
Department of Family and Community Medicine, School of Medicine, University of California, San Francisco 94143.
Egerter
S
S
Bennett
T
T
Showstack
J
J
D002140:California; D005249:Fees and Charges / Q000706:statistics & numerical data; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000191:economics* / Q000628:therapy; D007350:Insurance, Hospitalization / Q000706:statistics & numerical data*; D007363:Intensive Care Units, Neonatal / Q000191:economics* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D010067:Ownership / Q000191:economics; D018579:Patient Selection; D040841:Resource Allocation; D012189:Retrospective Studies; D014481:United States