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Int J Environ Res Public Health. 2015 Dec 22;13(1):ijerph13010029. doi: 10.3390/ijerph13010029.

Inpatient Hospitalization Costs: A Comparative Study of Micronesians, Native Hawaiians, Japanese, and Whites in Hawai'i.

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Office of Public Health Studies, University of Hawai'i at Manoa, 1960 East-West Road, Honolulu, HI 96822, USA.
Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, 677 Ala Moana Boulevard, Suite 1025, Honolulu, HI 96813, USA.
Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawai'i, 95-390 Kuahelani Avenue, Mililani, Hawai'i 96789, USA.
Hawaii Health Information Corporation, 733 Bishop St # 1870, Honolulu, HI 96813, USA.
Office of Public Health Studies, University of Hawai'i, 1960 East-West Road, Honolulu, HI 96822, USA.


Considerable interest exists in health care costs for the growing Micronesian population in the United States (US) due to their significant health care needs, poor average socioeconomic status, and unique immigration status, which impacts their access to public health care coverage. Using Hawai'i statewide impatient data from 2010 to 2012 for Micronesians, whites, Japanese, and Native Hawaiians (N = 162,152 hospitalizations), we compared inpatient hospital costs across racial/ethnic groups using multivariable models including age, gender, payer, residence location, and severity of illness (SOI). We also examined total inpatient hospital costs of Micronesians generally and for Medicaid specifically. Costs were estimated using standard cost-to-charge metrics overall and within nine major disease categories determined by All Patient Refined Diagnosis Related Groups. Micronesians had higher unadjusted hospitalization costs overall and specifically within several disease categories (including infectious and heart diseases). Higher SOI in Micronesians explained some, but not all, of these higher costs. The total cost of the 3486 Micronesian hospitalizations in the three-year study period was $58.1 million and 75% was covered by Medicaid; 23% of Native Hawaiian, 3% of Japanese, and 15% of white hospitalizations costs were covered by Medicaid. These findings may be of particular interests to hospitals, Medicaid programs, and policy makers.


Micronesians; Pacific Islander; costs; health equity; hospitalization

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