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Insurance status and hospital care for myocardial infarction, stroke, and pneumonia.
J Hosp Med. 2010 Oct; 5(8):452-9.JH

Abstract

BACKGROUND

Despite widely documented variations in health care outcomes by insurance status, few nationally representative studies have examined such disparities in the inpatient setting.

OBJECTIVE

To determine whether there are insurance-related differences in hospital care for 3 common medical conditions.

DESIGN AND SUBJECTS

Retrospective database analysis of 154,381 adult discharges (age 18-64 years) with a principal diagnosis of acute myocardial infarction (AMI), stroke, or pneumonia from the 2005 Nationwide Inpatient Sample (NIS).

MEASUREMENTS

For each diagnosis, we compared in-hospital mortality, length of stay (LOS), and cost per hospitalization for Medicaid and uninsured patients with the privately insured.

RESULTS

Compared with the privately insured, in-hospital mortality among AMI and stroke patients was significantly higher for the uninsured (adjusted odds ratio [OR] 1.52, 95% confidence interval [CI] [1.24-1.85] for AMI and 1.49 [1.29-1.72] for stroke) and among pneumonia patients was significantly higher for Medicaid recipients (1.21 [1.01-1.45]). Excluding patients who died during hospitalization, LOS was consistently longer for Medicaid recipients for all 3 conditions (adjusted ratio 1.07, 95% CI [1.05-1.09] for AMI, 1.17 [1.14-1.20] for stroke, and 1.04 [1.03-1.06] for pneumonia), although costs were significantly higher for Medicaid recipients for only 2 of the 3 conditions (adjusted ratio 1.06, 95% CI [1.04-1.09] for stroke and 1.05 [1.04-1.07] for pneumonia).

CONCLUSIONS

In this nationally representative study of working-age Americans hospitalized for 3 common medical conditions, significantly lower in-hospital mortality was noted for privately insured patients compared with the uninsured or Medicaid recipients. Interventions to reduce insurance-related gaps in inpatient quality of care should be investigated.

Authors+Show Affiliations

Department of Medicine, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02120-1613, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20540165

Citation

Hasan, Omar, et al. "Insurance Status and Hospital Care for Myocardial Infarction, Stroke, and Pneumonia." Journal of Hospital Medicine, vol. 5, no. 8, 2010, pp. 452-9.
Hasan O, Orav EJ, Hicks LS. Insurance status and hospital care for myocardial infarction, stroke, and pneumonia. J Hosp Med. 2010;5(8):452-9.
Hasan, O., Orav, E. J., & Hicks, L. S. (2010). Insurance status and hospital care for myocardial infarction, stroke, and pneumonia. Journal of Hospital Medicine, 5(8), 452-9. https://doi.org/10.1002/jhm.687
Hasan O, Orav EJ, Hicks LS. Insurance Status and Hospital Care for Myocardial Infarction, Stroke, and Pneumonia. J Hosp Med. 2010;5(8):452-9. PubMed PMID: 20540165.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insurance status and hospital care for myocardial infarction, stroke, and pneumonia. AU - Hasan,Omar, AU - Orav,E John, AU - Hicks,LeRoi S, PY - 2010/6/12/entrez PY - 2010/6/12/pubmed PY - 2011/2/5/medline SP - 452 EP - 9 JF - Journal of hospital medicine JO - J Hosp Med VL - 5 IS - 8 N2 - BACKGROUND: Despite widely documented variations in health care outcomes by insurance status, few nationally representative studies have examined such disparities in the inpatient setting. OBJECTIVE: To determine whether there are insurance-related differences in hospital care for 3 common medical conditions. DESIGN AND SUBJECTS: Retrospective database analysis of 154,381 adult discharges (age 18-64 years) with a principal diagnosis of acute myocardial infarction (AMI), stroke, or pneumonia from the 2005 Nationwide Inpatient Sample (NIS). MEASUREMENTS: For each diagnosis, we compared in-hospital mortality, length of stay (LOS), and cost per hospitalization for Medicaid and uninsured patients with the privately insured. RESULTS: Compared with the privately insured, in-hospital mortality among AMI and stroke patients was significantly higher for the uninsured (adjusted odds ratio [OR] 1.52, 95% confidence interval [CI] [1.24-1.85] for AMI and 1.49 [1.29-1.72] for stroke) and among pneumonia patients was significantly higher for Medicaid recipients (1.21 [1.01-1.45]). Excluding patients who died during hospitalization, LOS was consistently longer for Medicaid recipients for all 3 conditions (adjusted ratio 1.07, 95% CI [1.05-1.09] for AMI, 1.17 [1.14-1.20] for stroke, and 1.04 [1.03-1.06] for pneumonia), although costs were significantly higher for Medicaid recipients for only 2 of the 3 conditions (adjusted ratio 1.06, 95% CI [1.04-1.09] for stroke and 1.05 [1.04-1.07] for pneumonia). CONCLUSIONS: In this nationally representative study of working-age Americans hospitalized for 3 common medical conditions, significantly lower in-hospital mortality was noted for privately insured patients compared with the uninsured or Medicaid recipients. Interventions to reduce insurance-related gaps in inpatient quality of care should be investigated. SN - 1553-5606 UR - https://www.unboundmedicine.com/medline/citation/20540165/Insurance_status_and_hospital_care_for_myocardial_infarction_stroke_and_pneumonia_ L2 - https://doi.org/10.1002/jhm.687 DB - PRIME DP - Unbound Medicine ER -