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Discharge, Interhospital Transfer Varies With Insurance Status

MONDAY, April 1, 2019 -- Uninsured patients and Medicaid beneficiaries with acute pulmonary diseases have higher odds of interhospital transfer, according to a study published online April 1 in JAMA Internal Medicine.

Arjun K. Venkatesh, M.D., from the Yale University School of Medicine in New Haven, Connecticut, and colleagues conducted a cross-sectional analysis of the 2015 National Emergency Department Sample to examine the differences in risk-adjusted transfer and discharge rates by patient insurance status among hospitals capable of providing critical care. Data were included for 215,028 adult emergency department visits for the three common medical conditions of pneumonia, chronic obstructive pulmonary disease, and asthma at hospitals with intensive care capabilities.

The researchers found that across emergency departments, there was considerable variation in unadjusted and risk-standardized emergency department discharge, emergency department transfer, and hospital admission rates. Uninsured patients were more likely to be discharged and transferred compared with privately insured patients (odds ratios, 1.66 [95 percent confidence interval, 1.57 to 1.76] and 2.41 [95 percent confidence interval, 2.08 to 2.79], respectively). The odds of discharge were comparable for Medicaid beneficiaries (adjusted odds ratio, 1.00; 95 percent confidence interval, 0.97 to 1.04), while the odds of transfer were higher (adjusted odds ratio, 1.19; 95 percent confidence interval, 1.05 to 1.33).

"We found differences in access to hospital care based on patient insurance status, suggesting a unique modern-day barrier to hospitalization for common medical conditions," the authors write.

Several authors disclosed financial ties to the pharmaceutical, medical device, medical technology, and health insurance industries.

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Posted: April 2019

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