Uninsured hospitalizations: rural and urban differences.
BACKGROUND
Few studies have examined hospitalization patterns among the uninsured, especially from the perspective of rural and urban differences.


OBJECTIVE
To examine whether the patterns of uninsured hospitalizations differ in rural and urban hospitals and to identify the most prevalent and costly diagnoses among uninsured hospitalizations.


METHODS
We conducted a cross-sectional analysis of the Healthcare Cost and Utilization Project's National Inpatient Sample representing a total of 37,804,021 hospital discharges, with 4.9% of them generated by uninsured persons in 2002. We compared demographic and clinical characteristics and the proportion of frequent and costly diagnoses by rural and urban hospitals. We used multiple logistic regression models to examine the relationship between preventable conditions and rural and urban hospitals among uninsured hospitalizations.


RESULTS
Uninsured persons discharged from rural hospitals were more likely than their urban counterparts to be working-age adults (82% vs 79%) and to reside in a ZIP code area with a median household income of less than $35,000 per year (56% vs 26%). Rural uninsured hospitalizations were more likely to be for preventable conditions than were urban uninsured hospitalizations (P < .001). The proportion of total hospital charges related to preventable hospitalizations was 15.5% in rural hospitals versus 10.0% in urban hospitals.


CONCLUSIONS
The patterns of uninsured hospitalizations in rural and urban hospitals were different in many ways. Providing adequate access to primary care could result in potential savings related to preventable hospitalizations for the uninsured, especially for rural hospitals.
Zhang
Wanqing
W
Division of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4350, USA. wazhang@unmc.edu
Mueller
Keith J
KJ
Chen
Li-Wu
LW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D012424:Rural Population; D012737:Sex Factors; D012959:Socioeconomic Factors; D014505:Urban Population