title: Insurance status and mortality in critically ill patients.
abstract: OBJECTIVE
  The association between insurance status and outcome in critically ill patients is uncertain. We aimed to determine if there was an independent relationship between the presence or absence of compensable insurance status and mortality, after admission to the intensive care unit.
  
  
  METHODS
  We performed a retrospective cohort study in five public hospitals in Victoria, comprising adult patients admitted to the ICU between 2007 and 2012. We obtained data on demographics, severity of illness, chronic health status, insurance category, length of stay (LOS) and mortality. We matched socio-economic indices (collected from the Australian Bureau of Statistics) to postcodes. The primary outcome measured was in-hospital mortality. Secondary outcomes were ICU mortality, and ICU and hospital LOS, measured in days.
  
  
  RESULTS
  We studied 33 306 patients. Compensable patients comprised 21.2% of the study population (7046). Personal private insurance accounted for 13.4% (4451) and Transport Accident Commission insurance for 5.1% (1701) of compensable patients. Unadjusted in-hospital mortality was higher in publicly insured patients (13.4% v 10.6%, P < 0.0001). After adjusting for age, severity of illness, diagnosis and socio-economic status, being a compensable patient in a public hospital ICU was independently associated with a reduction in mortality (odds ratio, 0.73; 95% CI, 0.65-0.80; P < 0.001).
  
  
  CONCLUSIONS
  Among ICU patients treated in public hospitals in Victoria, being a compensable patient appears to be independently associated with a reduction in mortality. Further studies are needed to confirm and validate these findings elsewhere in Australia.
authors.affiliation: Department of Intensive Care, Barwon Health, Geelong, VIC, Australia. lgabri@barwonhealth.org.au.
authors.forename: Lucinda E K
authors.initials: LE
authors.lastname: Gabriel
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bailey
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Department of Intensive Care, Barwon Health, Geelong, VIC, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Stow
authors.affiliation: Department of Intensive Care, Barwon Health, Geelong, VIC, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Orford
authors.affiliation: Department of Intensive Care, Western Health, Melbourne, VIC, Australia.
authors.forename: Forbes
authors.initials: F
authors.lastname: McGain
authors.affiliation: Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Santamaria
authors.affiliation: Department of Intensive Care, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: Carlos
authors.initials: C
authors.lastname: Scheinkestel
authors.affiliation: Department of Intensive Care, The Alfred Hospital, Melbourne, VIC, Australia.
authors.forename: David V
authors.initials: DV
authors.lastname: Pilcher
mesh_terms: D000368:Aged; D001315:Australia; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors