Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland

Publisher Website
Google Scholar
Abstract
Objective.\p=m-\Todetermine whether uninsured and Medicaid patients have higher rates of avoidable hospitalizations than do insured patients. Design.\p=m-\Weused 1987 computerized hospital discharge data to select a cross-sectional sample of hospitalized patients. Population estimates from the Current Population Survey were used to estimate rates of admission, standardized for age and sex. Setting.\p=m-\Nonfederalacute care hospitals in Massachusetts and Maryland. Patients.\p=m-\Allpatients under 65 years of age who were uninsured, privately in- sured, or insured by Medicaid. Hospitalizations for obstetric and psychiatric condi- tions were excluded. Main Outcome Measures.\p=m-\Relativerisk of admission for 12 avoidable hospi- tal conditions (AHCs) identified by a physician panel. Results.\p=m-\Uninsuredand Medicaid patients were more likely than insured pa- tients to be hospitalized for AHCs. Rates for uninsured patients were significantly greater than for privately insured patients in Massachusetts for 10 of 12 individual AHCs, and in Maryland for five of 12 AHCs. After adjustment for baseline utiliza- tion, the results were statistically significant for 10 of 12 AHCs in Massachusetts and seven of 12 AHCs in Maryland. For Medicaid patients, rates were significantly greater than for privately insured patients for all AHCs in each state before adjust- ment, and for nine of 12 and seven of 12 AHCs in each state, respectively, after adjustment for baseline utilization. Conclusion.\p=m-\Ourfindings suggest that patients who are uninsured or who have Medicaid coverage have higher rates of hospitalization for conditions that can of- ten be treated out of hospital or avoided altogether. Our approach is potentially useful for routine monitoring of access and quality of care for selected groups of patients.

This publication has 0 references indexed in Scilit: