PMID- 10098566
OWN - NLM
STAT- MEDLINE
DCOM- 19990413
LR  - 20190822
IS  - 0025-7079 (Print)
IS  - 0025-7079 (Linking)
VI  - 37
IP  - 3
DP  - 1999 Mar
TI  - Variation in inpatient resource use in the treatment of HIV: do the privately 
      insured receive more care?
PG  - 220-7
AB  - OBJECTIVE: To estimate the impact of insurance status on inpatient resource use 
      after adjusting for health upon admission and site of care. DESIGN: Detailed 
      patient information linked to billing records from the AIDS Cost and Service 
      Utilization Survey (ACSUS), a longitudinal analysis of inpatient and outpatient 
      care between March 1991 and August 1992. SETTING: Hospitalizations of human 
      immunodeficiency virus (HIV) patients from 10 US cities with high incidence of 
      AIDS. PATIENTS: One thousand, nine hundred and forty nine adolescents and adults 
      at various stages of HIV. MAIN OUTCOME MEASURES: We estimate inpatient charges, 
      payments and length of stay as a function of patient, and provider and 
      reimbursement characteristics for more than 1,500 hospitalizations to HIV 
      patients. We control for patient characteristics and underlying risk factors 
      including disease stage, CD4 percentage, mode of transmission, discharge status, 
      type of admission, and region. We use hospital-fixed effects to control for 
      unmeasured differences across facilities. RESULTS: Unadjusted means indicate that 
      uninsured patients or patients covered by public insurance have significantly 
      lower charges and payments than privately insured patients with similar medical 
      conditions. We find that those differences are substantially reduced after 
      controlling for the hospital in which care is received. Further, we find little 
      evidence that "underinsured" patients are discharged sooner on average. 
      CONCLUSIONS: Inpatient resource use is affected by both the hospital in which 
      care is received and the type of patient admitted. Failure to control for 
      unmeasured differences across hospitals is likely to overstate the impact of 
      insurance substantially.
FAU - Joyce, G F
AU  - Joyce GF
AD  - Rand Health Sciences Program, Santa Monica, CA 90407-2138, USA. gjoyce@rand.org
FAU - Goldman, D P
AU  - Goldman DP
FAU - Leibowitz, A
AU  - Leibowitz A
FAU - Carlisle, D
AU  - Carlisle D
FAU - Duan, N
AU  - Duan N
FAU - Shapiro, M F
AU  - Shapiro MF
FAU - Bozzette, S A
AU  - Bozzette SA
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Med Care
JT  - Medical care
JID - 0230027
SB  - IM
CIN - Med Care. 1999 Apr;37(4):325-8. PMID: 10213012
MH  - Adolescent
MH  - Adult
MH  - Female
MH  - HIV Infections/etiology/*therapy/transmission
MH  - Health Care Surveys
MH  - Health Resources/*statistics & numerical data
MH  - Hospital Charges/statistics & numerical data
MH  - Hospitals/*statistics & numerical data
MH  - Humans
MH  - *Insurance, Hospitalization
MH  - Length of Stay/statistics & numerical data
MH  - Longitudinal Studies
MH  - Male
MH  - Medicaid/statistics & numerical data
MH  - Medically Uninsured/*statistics & numerical data
MH  - Quality of Health Care/*economics/statistics & numerical data
MH  - United States
EDAT- 1999/03/31 00:00
MHDA- 1999/03/31 00:01
CRDT- 1999/03/31 00:00
PHST- 1999/03/31 00:00 [pubmed]
PHST- 1999/03/31 00:01 [medline]
PHST- 1999/03/31 00:00 [entrez]
AID - 10.1097/00005650-199903000-00002 [doi]
PST - ppublish
SO  - Med Care. 1999 Mar;37(3):220-7. doi: 10.1097/00005650-199903000-00002.