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Comparison of uninsured and privately insured hospital patients. Condition on admission, resource use, and outcome
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1991
Year
Health Insurance DesignHealth Care AccountingSurgeryHealth Care FinanceInsurance StatusHealth Care ManagementHospital MedicineAdverse EventManaged CareInsurance RegulationsPublic HealthHealth Services ResearchInsured Hospital PatientsHealth PolicyDischarge AbstractsHealth InsuranceOutcomes ResearchHealth ReimbursementSurgical CareHealth Care DeliveryHospitalizationHealth SystemsHealth EconomicsMedical MalpracticeHealth Care ReimbursementPatient SafetyHealth Care CostResource UseMedicineEmergency Medicine
The study examined 592,598 1987 hospital discharges to assess how insurance status relates to admission condition, resource use, and in‑hospital mortality. Uninsured patients faced 44–124% higher mortality risk at admission, 1.2–3.2 times higher in‑hospital death rates, were 29–75% less likely to receive high‑cost or high‑discretion procedures, and 50% less likely to have normal pathology results, underscoring a broad association between insurance status and hospital care. Published in JAMA 1991;265:374‑379.
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. (<i>JAMA</i>. 1991;265:374-379)