Article Figures & Data
Tables
Characteristic Total Self-pay Medicaid All Other Payments P Value Unweighted, N 849,866 56,760 181,285 611,821 Population estimate 90,221,173 6,663,875 20,271,164 63,286,134 Insurance, % Self-pay 7.4 Medicaid 22.5 All other payments 70.2 Age in years, % 18–44 54.5 61.3 71.3 48.5 <.01 45–64 45.5 38.7 28.7 51.5 Sex, % Male 36.1 49.8 25.0 38.3 <.01 Female 63.9 50.2 75.0 61.7 Race, % White 56.5 53.0 48.8 59.4 <.01 Nonwhite 18.8 22.7 26.3 16.0 Not stated 24.7 24.3 24.8 24.7 Ambulatory care–sensitive conditions, % Yes 12.7 17.6 11.8 12.5 <.01 No 87.3 82.4 88.2 87.5 Hospital ownership, % Proprietary 13.3 8.9 15.2 13.1 <.01 Government 12.7 24.2 17.3 10.0 Nonprofit 74.0 67.0 67.5 76.9 Died in the hospital, % Yes 1.0 1.3 1.0 1.0 .06 No 99.0 98.7 99.0 99.0 - Table 2
Unadjusted Length of Stay For Patients Aged 18 to 64 Years, by Principal Expected Source of Payment
Mean Length of Stay, d P Valuea Hospital Ownership Self-pay Medicaid All Other Payments Self-pay vs Medicaid Self-pay vs All Other Medicaid vs All Other ACSC All 2.61 3.19 2.89 <.01 <.01 <.01 Proprietary hospital 2.51 3.46 3.03 <.01 .03 <.01 Government hospital 2.69 3.13 2.89 <.01 .01 .05 Nonprofit hospital 2.58 3.19 2.89 <.01 <.01 <.01 Non-ACSC All 2.74 2.94 2.89 .02 <.01 .40 Proprietary hospital 2.56 2.74 3.19 .03 <.01 <.01 Government hospital 2.94 3.00 2.94 .77 .99 .75 Nonprofit hospital 2.72 3.00 2.83 <.01 <.01 .04 -
ACSC=ambulatory care–sensitive condition.
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↵a P value based on difference in days.
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- Table 3
Adjusted Length of Stay for Patients Aged 18 to 64 Years, by Principal Expected Source of Payment
Mean Length of Stay, d P Valuea Hospital Ownership Self-pay Medicaid All Other Payments Self-pay vs Medicaid Self-pay vs All Other Medicaid vs All Other ACSC All 2.77 3.19 2.89 <.01 .04 <.01 Proprietary hospital 2.64 3.49 3.03 <.01 .09 <.01 Government hospital 2.83 3.06 2.83 .03 .90 .06 Nonprofit hospital 2.77 3.16 2.86 <.01 .08 <.01 Non-ACSC All 2.74 3.13 2.86 <.01 .01 <.01 Proprietary hospital 2.64 3.03 3.19 <.01 <.01 <.01 Government hospital 2.89 3.06 2.83 .16 .60 .03 Nonprofit hospital 2.72 3.16 2.80 <.01 .03 <.01 -
ACSC=ambulatory care–sensitive condition.
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Note: Adjusted for age, sex, race, and Deyo-Charlson Comorbidity Index.
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↵a P value based on difference in days.
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Mean Length of Stay, d P Valuea Hospital Ownership Proprietary Hospital Government Hospital Nonprofit Hospital Proprietary vs Government Proprietary vs Nonprofit Government vs Nonprofit ACSC All 3.10 2.89 2.92 <.01 .02 .61 Self-pay 2.64 2.83 2.77 .28 .56 .49 Medicaid 3.49 3.06 3.16 .04 .02 .31 All other payments 3.03 2.83 2.86 .01 .03 .59 Non-ACSC All 3.10 2.92 2.86 .02 <.01 .04 Self-pay 2.64 2.89 2.72 .01 .28 .03 Medicaid 3.03 3.06 3.16 .61 .16 .35 All other payments 3.19 2.83 2.80 <.01 <.01 .12 -
ACSC=ambulatory care–sensitive condition.
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Note: Adjusted for age, sex, race, and Deyo-Charlson Comorbidity Index.
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↵a P value based on difference in days.
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- Table 5
Adjusted Logistic Regressions for In-Hospital Mortality of Patients Aged 18 to 64 Years, by Principal Expected Source of Payment
Hospital Ownership Self-pay OR (95% CI) Medicaid OR (95% CI) All Other Payments OR (95% CI) ACSC All 1.00 (–) 1.85 (0.82–4.19) 1.31 (0.67–2.56) Proprietary hospitala 1.00 (–) – – Government hospitala 1.00 (–) – – Nonprofit hospital 1.00 (–) 1.01 (0.44–2.31) 0.93 (0.47–1.83) Non-ACSC All 1.00 (–) 0.81 (0.67–0.98) 0.58 (0.50–0.67) Proprietary hospital 1.00 (–) 0.68 (0.35–1.33) 0.34 (0.21–0.54) Government hospital 1.00 (–) 0.81(0.60–1.11) 0.83 (0.63–1.10) Nonprofit hospital 1.00 (–) 0.82 (0.65–1.04) 0.59 (0.49–0.71) -
ACSC=ambulatory care–sensitive condition; OR=odds ratio.
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Note: Adjusted for age, sex, race, and Deyo-Charlson Comorbidity Index.
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↵a Too few deaths in self-pay group for reliable estimates for Medicaid and all other payments.
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Additional Files
The Article in Brief
Impact of Insurance and Hospital Ownership on Hospital Length of Stay Among Patients With Ambulatory Care-Sensitive Conditions
Arch G. Mainous III, and colleagues
Background Research has suggested that for-profit US hospitals maximize financial margins from patient care by limiting therapies or decreasing length of stay for uninsured patients. This study examines whether lack of health insurance is related to length of stay and risk of mortality in for-profit and not-for-profit hospitals. The study examines hospitalizations for both Ambulatory Care-Sensitive Conditions (ACSCs, conditions in which hospitalizations may be avoidable with preventive care and early disease management in the outpatient setting) and non-ACSCs.
What This Study Found Patients without insurance have significantly shorter hospital stays, regardless of whether they are hospitalized for an ACSC or non-ACSC. Across all hospital types, the average length of stay for ACSCs was 2.77 days for uninsured individuals, 2.89 days for those with private insurance, and 3.19 days for those with Medicaid. Patients without insurance have a higher likelihood of death for non-ACSCs, but not for ACSCs.
Implications
- The authors call on clinicians to advocate for equal treatment of patients, regardless of insurance or payment status.
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