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Do Gaps in Insurance Coverage Increase Ambulatory-sensitive ER/Inpatient Visits? Who Pays?

Do Gaps in Insurance Coverage Increase Ambulatory-sensitive ER/Inpatient Visits? Who Pays? . Hsou Mei Hu 1 , Emily C. Shelton 1 , David M. Cutler 2 , Allison B. Rosen 1 1 University of Michigan 2 Harvard University

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Do Gaps in Insurance Coverage Increase Ambulatory-sensitive ER/Inpatient Visits? Who Pays?

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  1. Do Gaps in Insurance Coverage Increase Ambulatory-sensitive ER/Inpatient Visits? Who Pays? Hsou Mei Hu1, Emily C. Shelton1, David M. Cutler2, Allison B. Rosen1 1 University of Michigan 2 Harvard University Funded by NIA, the Harvard Interfaculty Program for Health Systems Improvement, the Lasker Foundation

  2. Background • Gaps in insurance coverage lead to the same level of barriers to care and financial difficulties as uninsurance (Schoen & DesRoches, 2000). • People with chronic conditions experience barriers to medical care due to lack of insurance coverage (Pollitz, 2005; Beckles, 1998; Ayanian, 2000). AcademyHealth ARM, 6/27/2006

  3. Study Objectives • To study the effect of gaps in insurance coverage on the use and spending of ER and inpatient care for adults (age 18 to 64) with diabetes or asthma. • To examine whopays for the care, third party payers or patients? AcademyHealth ARM, 6/27/2006

  4. Data Source • Three 2-year panels of the Medical Expenditure Panel Survey (MEPS), spanning from 2000 to 2003. • A survey of civilian non-institutionalized U.S. population: health status, insurance coverage, health care use and expenditures for health services. • 5 rounds of interview. • Adults (age 18 to 64) reporting diabetes or asthma (n=4,408). AcademyHealth ARM, 6/27/2006

  5. Insurance Status Definition: • Continuous Insurance Coverage: insurance coverage all 5 rounds during the two-year survey. (n=3,160) • Gaps in Coverage: at least one round without insurance coverage (n=795) • Adults with no coverage (n=453) were excluded. AcademyHealth ARM, 6/27/2006

  6. Data Analysis • Descriptive statistics: • ER/inpatient visits and spending in 2003 dollars. • Payment by source • Regression analyses • Odds of having any ER visit, inpatient stay • adjusted ER visits, hospitalization, and spending. AcademyHealth ARM, 6/27/2006

  7. Findings: Individual Characteristics Compared with adults having continuous coverage, the group with gaps in coverage were • younger, • lower income, • more likely to be minority, • healthier. AcademyHealth ARM, 6/27/2006

  8. Finding II: ER/Hospitalization • Controlling for individual characteristics, health status: • Adults having gaps in coverage were more likely to have any ER visits than those with continuous coverage (OR=1.22, p=0.062) • No significant difference in the likelihood of having any hospitalization (OR=1.10, p=0.447) AcademyHealth ARM, 6/27/2006

  9. Finding III: Mean ER/Inpatient Stays per Person †Significant at =0.05 ‡Significant at =0.10. AcademyHealth ARM, 6/27/2006

  10. Finding IV: Mean Spending per ER/Inpatient Event • Continuous Coverage: $3,327 per event • Gaps in Coverage: $1,960 per event • Having coverage†: $2,042 per event • No coverage‡: $958 per event † mean spending during the period having insurance coverage. ‡ mean spending during the period with no reported health insurance. AcademyHealth ARM, 6/27/2006

  11. Finding V: ER/Inpatient Payment per Event by Source Gaps in coverage † mean spending during the period having insurance coverage. ‡ mean spending during the period with no reported health insurance. AcademyHealth ARM, 6/27/2006

  12. Conclusions • Gaps in insurance coverage is associated with increased ER visits. • Public programs and patients bear the most financial burden for each ambulatory-sensitive ER/inpatient visit for those without continuous insurance coverage. AcademyHealth ARM, 6/27/2006

  13. Limitations • Self-reported information • Not causal effect AcademyHealth ARM, 6/27/2006

  14. Policy Implication • Policies to fill insurance gaps may improve health and potentially even save money if applied in subpopulation, such as those with diabetes or asthma. AcademyHealth ARM, 6/27/2006

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