Health Information Management

News: Ability to pay drives hospital length of stay

CDI Strategies, December 8, 2011

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Uninsured patients spend less time in the hospital than insured patients, while Medicare patients stay hospitalized longer than any, according to a study published in the December issue of Annals of Family Medicine. The study examined nearly 850,000 adult discharges between 2003 and 2007, at for-profit, non-profit, and government hospitals nationwide. The study suggests that ability to pay plays a greater role than medical need when determining length of stay.

“The only two explanations we could come up with are either people without insurance are being discharged prematurely or hospitals are keeping people who can pay longer to increase revenue,” Arch G. Mainous, III, the author of the study, told HealthLeaders Media.
 
The findings show that in hospitalizations for ambulatory care-sensitive conditions (ACSC) – which should have been avoidable through disease management and preventive care — uninsured patients stayed an average of 2.8 days. Privately insured patients stayed an average of 2.9 days, and Medicaid patients averaged 3.2 days. For patients hospitalized with non-ACSCs, the average length of stay averaged 2.7 days for the uninsured, compared with 2.8 days for the privately insured, and 3.1 days for Medicaid patients.
 
“We have relatively robust findings that appear over and over that people without insurance, regardless of what they come in for, stay a shorter period of time, even on things where they might be sicker,” says Mainous, a researcher with the Department of Family Medicine at the Medical University of South Carolina, in Charleston.
 
“We controlled for how sick they were. We controlled for people who left the hospital early against medical advice. It still shows up,” he says.
 
The study found that in-hospital mortality for uninsured patients with non-ACSCs was higher than at both nonprofit and for-profit hospitals, while there was little difference in mortality among patients hospitalized for ACSCs.
 
Mainous says the findings “are not completely surprising but very distressing.”
 
“Healthcare businesses providing uncompensated care would be like providing uncompensated hamburgers at McDonald’s. There is only so much you can do in terms of supplying free stuff,” he says. “As we see the proportion of people without insurance continuing to rise, it is a wake-up call. Are we going to have a two-tiered system where there is going to be a small proportion of people who get a level of care and others who don’t?”
 
Mainous says the study isn’t about a chasm between rich and poor so much as it is about the insured and the uninsured. “If you look at the Medicaid group, they actually did well,” he says. “Those folks seem to stay in as long as the privately insured, or ever longer. The cut point for access to care is insurance.”
 
Editor’s Note: This article was originally published on the HealthLeaders Media web site.



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