Department of Family Medicine, Medical University of South Carolina, Charleston, 29425, USA.
Ann Fam Med. 2011 Nov-Dec;9(6):489-95. doi: 10.1370/afm.1315.
PURPOSE Some studies suggest proprietary (for-profit) hospitals are maximizing financial margins from patient care by limiting therapies or decreasing length of stay for uninsured patients. This study examines the role of insurance related to length of stay once the patient is in the hospital and risk for mortality, particularly in a for-profit environment. METHODS We undertook an analysis of hospitalizations in the National Hospital Discharge Survey (NHDS) of the 5-year period of 2003 to 2007 for patients aged 18 to 64 years (unweighted n = 849,866; weighted n = 90 million). The analysis included those who were hospitalized with both ambulatory care-sensitive conditions (ACSCs), hospitalizations considered to be preventable, and non-ACSCs. We analyzed the transformed mean length of stay between individuals who had Medicaid or all other insurance types while hospitalized and those who were hospitalized without insurance. This analysis was stratified by hospital ownership. We also examined the relationship between in-hospital mortality and insurance status. RESULTS After controlling for comorbidities; age, sex, and race/ethnicity; and hospitalizations with either an ACSC or non-ACSC diagnosis, patients without insurance tended to have a significantly shorter length of stay. Across all hospital types, the mean length of stay for ACSCs was significantly shorter for individuals without insurance (2.77 days) than for those with either private insurance (2.89 days, P = .04) or Medicaid (3.19, P <.01). Among hospitalizations for ACSCs, in-hospital mortality rate for individuals with either private insurance or Medicaid was not significantly different from the mortality rate for those without insurance. CONCLUSIONS Patients without insurance have shorter lengths of stay for both ACSCs and non-ACSCs. Future research should examine whether patients without insurance are being discharged prematurely.
一些研究表明，营利性（盈利）医院通过限制对未参保患者的治疗或减少住院时间，从患者护理中最大限度地获取财务利润。本研究考察了在患者住院期间与保险相关的作用，以及与死亡率相关的风险，特别是在营利性环境中。
我们对 2003 年至 2007 年期间的国家医院出院调查（NHDS）中 18 至 64 岁的住院患者（未加权 n = 849866；加权 n = 9000 万）进行了分析。该分析包括患有门诊医疗敏感条件（ACSCs）、被认为可预防的住院治疗和非 ACSC 的患者。我们分析了在医院期间有医疗补助或所有其他保险类型的个体与没有保险的个体之间的住院时间的变换平均值。该分析按医院所有权分层。我们还检查了住院期间死亡率与保险状况之间的关系。
在控制了合并症、年龄、性别和种族/民族以及 ACSC 或非 ACSC 诊断的住院治疗后，没有保险的患者住院时间明显缩短。在所有医院类型中，没有保险的个体 ACSC 的平均住院时间明显更短（2.77 天），而私人保险（2.89 天，P =.04）或医疗补助（3.19 天，P <.01）。在 ACSC 的住院治疗中，私人保险或医疗补助的个体的住院死亡率与没有保险的个体的死亡率没有显著差异。
没有保险的个体的 ACSC 和非 ACSC 的住院时间都更短。未来的研究应该检查没有保险的患者是否过早出院。
