Hospital Utilization Patterns For Medicaid and Uninsured Patients Differ From Insured

Raynard E. Washington, PhD, MPH Center for Delivery, Organization, and Markets Agency for Healthcare Research and Quality Rockville, MD 20850MedicalResearch.com Interview with:
Raynard E. Washington, PhD, MPH

Center for Delivery, Organization, and Markets
Agency for Healthcare Research and Quality
Rockville, MD 20850

Medical Research: What is the background for this study? What are the main findings?

Dr. Washington: Many individuals with low income who require a hospital stay are uninsured or covered by Medicaid, a joint Federal-State health insurance program for eligible individuals and families with low income. The difference in hospital utilization among patients covered by Medicaid and those who are uninsured may reflect differences in the characteristics of these populations and their level of access to health care. This HCUP Statistical Brief describes 2012 hospital stays with a primary expected payer of Medicaid and stays that were uninsured.

Of the 36.5 million total hospital inpatient stays in 2012, 20.9 percent had an expected primary payer of Medicaid and 5.6 percent were uninsured; 30.6 percent were covered by private insurance. Patients covered by Medicaid were on average younger and more likely to live in low-income areas than were patients with private insurance. Patients who were uninsured were more likely to be male and to live in low-income communities than were patients with private insurance. The majority of the top 10 diagnoses for Medicaid hospitalizations were ambulatory care sensitive conditions. Cholecystectomy (gall bladder removal) was the most common operating room procedure for Medicaid and uninsured stays.

Medical Research: What should clinicians and patients take away from your report?

Dr. Washington: There are appreciable differences in hospital utilization patterns and costs for patients covered by the Medicaid program and those without insurance, compared to patients with private insurance coverage. These differences have possible implications for the type of inpatient and outpatient services necessary to support this patient population. Hospitals and other healthcare facilities providing services to high proportions of patients covered by Medicaid and/or patients without insurance might consider these findings in their planning for care delivery.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Washington: Further inquiry and monitoring of changes in hospital utilization patterns and patient demographics of patients covered by Medicaid and the uninsured might provide some insights about the impact of expanded Medicaid services and health insurance subsidies provisioned by the Affordable Care Act. Additionally, future analyses might investigate further the specific causes of hospitalizations, specifically to assess potentially preventable hospitalizations, as an indicator of access to primary care and preventive services for these vulnerable patient populations.

Citation:

 Lopez-Gonzalez L (Truven Health Analytics), Pickens GT (Truven Health Analytics), Washington R (AHRQ), Weiss AJ (Truven Health Analytics). Characteristics of Medicaid and Uninsured Hospitalizations, 2012. HCUP Statistical Brief #182. October 2014. Agency for Healthcare Research and Quality, Rockville, MD