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Int J Qual Health Care. 2019 Jun 1;31(5):325-330. doi: 10.1093/intqhc/mzy175.

Risk of health morbidity for the uninsured: 10-year evidence from a large hospital center in Boston, Massachusetts.

Author information

1
Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, Gainesville, Florida, USA.
2
Department of Health Outcomes and Biomedical Informatics, College of Public Health and Health Professions, University of Florida, 2004 Mowry Road, Gainesville, Florida, USA.
3
Department of Management, Warrington College of Business, University of Florida, PO Box 117165, Gainesville, Florida, USA.
4
Department of Work and Organizations, Carlson School of Management, University of Minnesota, 321 19th Ave SE, Minneapolis, Minnesota, USA.

Abstract

OBJECTIVE:

To investigate the independent contribution of insurance status toward the risk of diagnosis of specific clinical comorbidities for individuals admitted to intensive care unit (ICU).

DESIGN:

Retrospective analysis of secondary database.

SETTING:

Ten years of public de-identified ICU electronic medical records from a large hospital in USA.

PARTICIPANTS:

Patients (18-65 years old) who had private insurance or no insurance were extracted from the database.

MAIN OUTCOME MEASURES:

Independent association of insurance status (uninsured vs. privately insured) with the risk of diagnosis of specific clinical comorbidities.

RESULTS:

Among 14 268 (from 11 753 patients) admissions to ICU between 2001 and 2012, 96% of them were covered by private insurance. Patients with private insurance had higher proportion of females, married, White race, longer ICU stay and more procedures during stay, and fewer deaths. A lower CCI was observed in uninsured patients. At multivariable analysis, uninsured patients had higher odds of death and of admissions for accidental falls, substance or alcohol abuse.

CONCLUSIONS:

Patients with no insurance coverage were at higher risk of death and of admission for physical and substance-related injury. We did not observe a higher risk for acute life-threatening diseases such as myocardial infarction or kidney failure. The lower CCI observed in the uninsured may be explained by under diagnosis or voluntary withdrawal from coverage in the pre-Affordable Care Act era. Replication of findings is warranted in other populations, among those with government-subsidized insurance and in the procedure/prescription domains.

KEYWORDS:

health insurance; intensive care; morbidity

PMID:
30137334
DOI:
10.1093/intqhc/mzy175
[Indexed for MEDLINE]

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