Comparison of uninsured and privately insured hospital patients. Condition on admission, resource use, and outcome.
To investigate the association between insurance status and condition on admission, resource use, and in-hospital mortality, we analyzed discharge abstracts for 592,598 patients hospitalized in 1987 in a national sample of hospitals. In 13 of 16 age-sex-race-specific cohorts, the uninsured had a 44% to 124% higher risk of in-hospital mortality at the time of admission than did the privately insured. After controlling for this difference, the actual in-hospital death rate was 1.2 to 3.2 times higher among uninsured patients in 11 of 16 cohorts. The uninsured also were 29% to 75% less likely to undergo each of five high-cost or high-discretion procedures and 50% less likely to have normal results on tissue pathology reports for biopsies performed during five of seven different endoscopic procedures. Our results suggest that insurance status is associated with a broad spectrum of aspects of hospital care.
Hadley
J
J
Center for Health Policy Studies, Georgetown University School of Medicine, Washington, DC 20007.
Steinberg
E P
EP
Feder
J
J
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007350:Insurance, Hospitalization / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008489:Medical Indigency / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality; D010343:Patient Admission / Q000706:statistics & numerical data; D018579:Patient Selection; D011336:Probability; D011859:Radiography / Q000706:statistics & numerical data; D012044:Regression Analysis; D040841:Resource Allocation; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review