Blog | Tuesday, November 22, 2011

QD: News Every Day--Insurance status affects length of stay for some hospitalized patients

Patients without insurance have shorter lengths of stay when admitted to for-profit hospitals for preventable illnesses, researchers found.

Researchers analyzed length of stay for insured and uninsured patients by for- and non-profit hospital status. The study applied data from the National Hospital Discharge Survey (NHDS) from 2003 to 2007 for patients ages 18 to 64 years. The analysis included those who were hospitalized with both ambulatory care-sensitive conditions (ACSCs), which were considered to be preventable, and non-ACSCs.

Ambulatory care-sensitive conditions were defined as those conditions for which hospitalizations are thought to be avoidable through preventative care and early disease management: seizures; ear, nose and throat infections; chronic obstructive pulmonary disease; bacterial pneumonia; asthma; congestive heart failure; hypertension; angina; cellulitis; diabetes; hypoglycemia; gastroenteritis and dehydration; and kidney and urinary infections. Non-ACSCs were also studied for comparison. Hospitalizations were excluded if patients left against medical advice.

Results appeared in the November/December issue of the Annals of Family Medicine.

After controlling for comorbidities; age, sex, and race/ethnicity; and hospitalizations with either an ACSC or non-ACSC diagnosis, patients without insurance tended to have a significantly shorter length of stay across all hospital types (2.77 days) than for those with either private insurance (2.89 days, P=.04) or Medicaid (3.19, P less than .01). In-hospital mortality rates were not significantly different among types of insurance, the researchers noted.

Across all hospital types, the length of stay for those without insurance was shorter in an adjusted analysis of ACSCs. ACSCs treated in government hospitals showed no significant difference in length of stay regardless of whether the patient had insurance, other than Medicaid or was not insured, researchers noted.

The authors wrote, "Because of the nature of ACSCs, we would expect that individuals who lack access to health care as a result of no insurance would arrive at a hospital with a more severe illness. Instead, our study found that length of stay for patients with ACSC diagnoses was shorter for those without insurance, results similar to those for non-ACSC diagnoses."