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Estimates of the Uninsured from Hospital Emergency Department and Inpatient Data
Susan Forbes, DrPHJill Miyamura, Ph.D.R. Scott Daniels, Ph.D.Hawaii Health Information Corporation
Hawaii Coverage for All ProjectTechnical Workshop VISeptember 17, 2004
3 Data Sets for Hospital Data
Emergency Department (ED) Visits from 15 out of 17 hospitals with EDs
Inpatient Discharges from 23 out of 23 acute care hospitals
Financial Data—relied on both DataBank, survey data reported to AHA, and cost reports analyzed by E&Y
Collected by HHIC in concert with our mission to collect, analyze and disseminate statewide health information to support efforts to continually improve the quality and cost-efficiency of health care services provided to the people of Hawaii.
Questions to be answered with hospital data:
Emergency Department (ED) Data: What does ED data tell us about the
uninsured? Is there any difference between the insured and
uninsured in the nature of ED visits? What is the insurance status of patients
admitted to the hospital from the ED, and how has this changed over time?
For patients admitted to the hospital from the ED, is there a difference in principal diagnosis by insurance status?
Questions to be answered with hospital data—continued:
Preventable Hospitalizations:What proportion of total
hospitalizations are “[potentially] preventable”?
Do [potentially] preventable hospitalizations vary by payer?
How have [potentially] preventable hospitalizations changed over time?
Questions to be answered with hospital data—continued:
Financial Impacts How do charges for emergency department
visits vary by insurance status? What are the total charges for each payer
type (private, government, uninsured)? How does hospital care of the uninsured
impact the financial health of a hospital? How has bad debt changed over time?
Emergency Department
What does ED data tell us about the uninsured?
Uninsured ED Visits by Sex
Uninsured ED Visits by Sex and Age, 2002
Uninsured ED Visits by Island, 2002
ED Data--Continued
Is there any difference between the insured and uninsured in the nature of ED visits?
Top 10 Reasons for ED Visit by Insured Status, 2002
Top Reasons for ED Dental
Top Reasons for ED Infectious Disease
From ED to Inpatient
What is the insurance status of patients admitted to the hospital from the ED, and how has this changed over time?
…is there a difference in principal diagnosis by insurance status?
Inpatient Admissions from ED by Insurance Status
Top Ten Reasons for Admission from ER by Status, 1995-2003
Potentially Preventable Hospitalizations
What proportion of total hospitalizations are potentially preventable?
Do potentially preventable hospitalizations vary by payer?
How have potentially preventable hospitalizations changed over time?
Preventable Hospitalization by Insurance Status
Preventable Hospitalizations by Payer
Preventable Hospitalizations Charges by Payer
Preventable Hospitalizations ALOS by Payer
Preventable Hospitalizations by County
Preventable Hospitalizations by County and Insured Status
Financial Impacts
How do charges for emergency department visits vary by insurance status?
ED Charge per Visit by Insured Status
ED Charge per Visit by Payer
Financial Impacts--continued
How does hospital care (ED and inpatient) impact the financial health of a hospital?
How has bad debt changed over time?
Burden to the Hospitals
In 2002, charges to the uninsured were over $50 million for ED and inpatient combined
0%1%2%3%4%5%6%7%8%9%
10%
6-24 25-49 50-99 100-199 200-299 300-399 400-499 500 PlusBed Size Categories
% o
f Cha
rge
Jan-Sept 2003 2002 2001
U.S. Hospitals Charity and Bad Debt 2001 – Sept. 2003
U.S. hospitals uncompensated care to total charges gap increasing from 4.8% in 2001 to 5.3% in 2003
Larger hospitals (400 – 500+ beds) had larger uncompensated care to total charges of 4.6% in 2001 to 8.1% in 2003.
Hospitals with 300 – 399 beds had lower uncompensated care to total charges of 3.1% - 3.6% from 2001 to 2003
Uncompensated Care – Charity & Bad Debt
Source: DATABANKHealthcare Association of Hawaii Report, 2003
Hawaii Charity Care & Bad Debt, 1998 - 2003 The average annual charity care 1998 – 2003 for the Hawaii
hospitals was $79.3 million with a total of just over $476 million for the six year period
“Queen’s Medical Center absorbed $23 million in bad debt and charity care for the fiscal year ended June 30, 2003”
12/21/2003 Rix Maurer, Queen’s Health System CFO
“For Hawaii Pacific Health, when all the shortfalls are added from various programs and under-reimbursements are included, the losses move closer to $47 million for the fiscal year ended June 30, 2003”
12/21/2003 Dave Heywood, Hawaii Pacific Health VP
Source: Healthcare Association of Hawaii Report, November 2003
Honolulu Star Bulletin Hawaii’s hospitals see continuing losses as reimbursements tumble, December 21, 2003
Uncompensated Care – Charity Care and Bad Debt
Increased charity care (43.7 million U.S. uninsured), will likely cause hospital revenue to grow at a slower pace than expenses, causing moderate decline in profitability
Hawaii hospitals provide services regardless of ability to pay resulting in bad debt expense and charity care
As the percentage of uninsured in Hawaii increases, bad debt and charity care increase
Source: Healthcare Association of Hawaii Report, November 2003
Questions?
Mahalo!
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