Admitted uninsured patients less likely to undergo interhospital transfer

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1. In the United States, uninsured patients who are hospitalized were significantly less likely to undergo interhospital transfer compared to patients with private insurance. 

Evidence Rating Level: 2 (Good)          

Study Rundown: Previous studies have suggested that uninsured patients presenting to the emergency department are more likely to undergo interhospital transfer, however, the evidence on already hospitalized patients was limited. This study used 2010 data from the Nationwide Inpatient Sample (NIS) to examine the relationship of various non-medical patient characteristics, in particular insurance status, and the rate of interhospital transfer. The authors hypothesized that they would identify a similar relationship to those suggested by previous studies on emergency department patients. However, the results of this study showed that uninsured patients were actually significantly less likely to undergo inter-hospital transfer compared to those patients with private insurance. It is possible that this phenomenon is related to the reluctance on behalf of the accepting hospital to admit uninsured patients in transfer. Interestingly, the study also suggested that women are also less likely to be transferred then men. This study has several limitations, including the lack of information regarding the patients’ request for transfer and the type of hospital to which the patients were transferred. Nonetheless, this study provides further evidence for the influence of non-medical factors in determining the decision for inter-hospital transfer.

Click to read the study, published today in the Annals of Internal Medicine

Relevant Reading:  Patient transfers: medical practice as a social triage

In-Depth [retrospective cohort study]: Using 2010 discharge data from the NIS, the study population included adults between 18-64 years of age at hospitalization (patients >65 years of age are generally insured by Medicare). Five of the more common diagnoses were identified from discharge abstracts for further study: biliary tract disease, chest pain, septicemia, skin/subcutaneous tissue infection, and pneumonia. The outcome of interest was discharge disposition, in particular whether the patient was transferred to another hospital. In total, the analysis included 315,748 discharges, of which 2.6% involved interhospital transfer. The study findings also demonstrated that uninsured patients were significantly less likely to be transferred than privately insured patients for all 5 of the studied diagnoses. This finding was consistent after adjustment for patient demographics, comorbid conditions and hospital-level factors for all the 5 studied diagnoses, except pneumonia. Notably, it was also found that women were 35-40% less likely to be transferred then men.

By Aimee Li, MD and Andrew Cheung, MD

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