Follow-up after hospital discharge: does insurance make a difference?
As the length of hospital stays decreases, important medical problems are often deferred for follow-up after discharge. We investigated whether patients without regular physicians actually receive post-discharge care. Patients without regular physicians at the time of admission to a private nonprofit teaching hospital were surveyed by telephone one month after discharge. Forty-six percent were non-Caucasian and 53 percent had Medicaid or no insurance. Although discharge planning was documented for 97 percent of patients, only 54 percent of study participants had completed follow-up one month later and only 46 percent could identify a regular physician. Among all patients with a particular need for follow-up, Medicaid and uninsured patients were less likely to receive follow-up (p = 0.042), to identify a regular physician (p = 0.007), or to complete discharge instructions (p = 0.018). Cost of medical care was found to be a significant deterrent to obtaining follow-up for patients with Medicaid or with no insurance (p = 0.001). Expanded access to care, along with focused discharge planning, may improve completion of follow-up for Medicaid and uninsured patients.
Kerr
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UCLA Department of Medicine 90024.
Siu
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D000359:Aftercare / Q000191:economics* / Q000458:organization & administration / Q000639:trends; D002140:California; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured / Q000208:ethnology / Q000706:statistics & numerical data; D006278:Medicare; D010351:Patient Discharge / Q000191:economics*; D010817:Physician-Patient Relations; D011787:Quality of Health Care / Q000191:economics*; D014481:United States