Differences in Hospital Resource Allocation among Sick Newborns According to Insurance Coverage
To assess whether newborns' insurance coverage was associated with differences in the allocation of hospital services.
Retrospective analysis of computerized hospital discharge data, comparing resource allocation among newborns according to insurance status, controlling for race/ethnicity, diagnoses, hospital characteristics (ownership, teaching status, nursery level), and disposition.
All California civilian acute-care hospitals.
Population-based sample, excluding out-of-hospital and military hospital births. Resource allocation was studied among all newborns discharged in 1987 with evidence of serious problems (N = 29,751).
Length of stay, total charges, and charges per day.
Sick newborns without insurance received fewer inpatient services than comparable privately insured newborns with either indemnity or prepaid coverage. This pattern was observed across all hospital ownership types. Mean stay was 15.7 days for all privately insured newborns (15.6 days for those with indemnity and 15.7 days for those with prepaid coverage), 14.8 days for Medicaid-covered newborns, and 13.2 days for uninsured newborns (P less than .001). Length of stay, total charges, and charges per day were 16%, 28%, and 10% less, respectively, for the uninsured than for all privately insured newborns (P less than .001). Resources for newborns covered by Medicaid were generally greater than for the uninsured and less than for the privately insured. Both uninsured and Medicaid-covered newborns were found to have more severe medical problems than the privately insured.
The findings cannot be explained by differences in medical need or by differences in non-medically indicated services; they constitute prima facie evidence of inequities that need to be addressed by policy changes.
Available from: Joseph P Newhouse
- "They have a much higher rate of adverse health outcomes, including low birthweight and prematurity (Haas et al., 1993). Moreover, sick uninsured newborns receive fewer resources while in the hospital (Braveman et al., 1991). "
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ABSTRACT: To assess the impact of Medicaid expan- sion for pregnant women in South Carolina and California, the authors compared change in rates of timely prenatal care, adverse infant and maternal health out- comes, and use of cesarean section for groups of pregnant women who were either uninsured or covered by Medicaid, versus women with private coverage. The results showed small and/or inconsistent changes. Provision of coverage may be the first logi- cal step in improving health care for the uninsured, but outcomes may rely more on outreach, coordination of care, and non- medical interventions than on provision of insurance coverage per se.
Health care financing review 01/1998; 19(4). · 2.06 Impact Factor
Available from: nih.gov
- "Babies born into poor families may require more resources than other newborns . In particular, poor babies are likely to have received less prenatal care and, therefore, to be at risk for more medical complications (Braveman et al. 1991). As a proxy for the poverty status of newborns most likely to be served at each hospital, we computed the percentage of the population below the poverty level in the communities nearest to each hospital. "
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ABSTRACT: To investigate the relationship between hospital financing patterns and hospital resources for the care of babies born at low birthweight in New York City.
Data on neonatal care beds in New York City hospitals for 1991, obtained from the Greater New York Hospital Association, which were matched to 1991 hospital-specific birthweight and payment distributions from the New York State Department of Health.
Statistical analyses were used to assess the relationship between insurance and beds across all hospitals and across hospitals classified by ownership and teaching status.
After adjusting for low birthweight and other measures of patient need and for hospital affiliation, the study finds that hospitals with more privately insured patients, especially those with more privately insured low-birthweight newborns, have statistically significantly more neonatal intensive care beds than do those with fewer such patients. This result persists within hospital affiliation categories.
These results suggest that differences in the care received by privately insured, Medicaid insured, and uninsured low-birthweight babies may stem from differences in the resources available to the hospitals that treat these patients.
Health Services Research 01/1997; 31(5):593-607. · 2.78 Impact Factor
Available from: Kevin M. Gorey
Canadian journal of public health. Revue canadienne de santé publique 03/1998; 89(2):102-4. · 1.02 Impact Factor
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