title: Insurance and inpatient care: differences in length of stay and costs between surgically treated cancer patients.
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 = 781) or colorectal cancer (CRC) (n = 8190) or who underwent mastectomy (n = 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 Medicaid-insured 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.
authors.affiliation: Department of Healthcare Policy and Research, Massey Cancer Center, Richmond, VA 23298-0430, USA. cjbradley@vcu.edu
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
authors.forename: Bassam
authors.initials: B
authors.lastname: Dahman
authors.forename: Harry D
authors.initials: HD
authors.lastname: Bear
mesh_terms: D001943:Breast Neoplasms / Q000191:economics; D005260:Female; D017048:Health Care Costs; D054625:Healthcare Disparities; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients; D019458:Insurance Coverage / Q000191:economics*; D007348:Insurance, Health / Q000191:economics*; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008484:Medicaid / Q000191:economics; D017057:Medically Uninsured; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000601:surgery* / Q000628:therapy; D014481:United States