Disparities Between Medicaid and Privately-Insured Patients Extend to Emergency Surgery: Medicaid Patients can Expect Less Surgery and More In-hospital Morbidity
*Jahnavi Kakuturu1, *Natalie Pozzi1, *Ann Friedrich1, *Rachelle Damle2, *Allison Wyman1, Demetrius Litwin1, Mitchell Cahan1
1University of Massachusetts, Worcester, MA;2Saint Louis University, St. Louis, MO
Objective: This study presents a comprehensive, nationwide analysis of insurance status and delivery of care in patients presenting with diagnoses that typically require emergency surgery.
Patients: The University HealthSystem Consortium (UHC) database was used to identify adult patients age 18-65 years who presented with emergency surgery diagnoses from 2010-2015.
Main Outcome Measures: Insurance status with Medicaid or Private Insurance was compared using both univariate and multivariate analysis to assess differences in the percent of time surgery was performed, average time to surgery, in-hospital morbidity, rates of readmission and mortality.
Results: The study included 117,875 patients, 48% insured with Medicaid and 52% with Private Insurance. Medicaid patients had surgery performed less frequently (70% in the Medicaid group versus 76% in the Private group), experienced higher rates of in-hospital morbidity (4.6% in the Medicaid group versus 4.1% in the Private group) and had longer lengths of stay (5.4 days in the Medicaid group and 4.4 days in the Private group). Multivariate analysis controlling for age, race, severity of illness, and co-morbid conditions showed consistent results with Medicaid patients less likely to undergo surgery (OR 0.71,95%CI:0.69-0.73) and experiencing more in-hospital morbidity (OR 1.23,95%CI:1.13-1.33).
Conclusions: In emergency surgery patients, insurance coverage with Medicaid leads to differences in healthcare delivery when compared with the privately insured. Underlying systemic processes in hospitals across the United States may influence care for these patients who are taken to the operating room less frequently, suffer more in-hospital morbidity, and can expect longer hospital stays. Future studies should examine the regions and hospitals that are closing this gap to identify strategies to minimize differences in care and achieve better outcomes.
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