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PubMed2005

Health insurance, the uninsured, and hospitals: collision course.

The number of uninsured Americans is approaching 50 million, with little evidence that the situation will improve any time soon. Although the consequences of this are serious in many ways, the implications for hospitals are especially severe, as they are the providers of care of last resort. Among the most serious problems for hospitals that treat uninsured patients are financial losses; difficulties in planning and in allocating resources; the need to make painful choices; litigation, both public and private; loss of community faith; the possible closing of needed institutions; and a perception of moral failure. The question is whether American hospitals have the will and the ability to stave off an impending disaster.

Community-Institutional Relations↗
PubMed2000

The new health insurance rebate: an inefficient way of assisting public hospitals.

Private health insurance subsidy is now estimated to cost $2.19 billion; government support for private health care includes a further $1.2 billion of Medicare benefits expenditure in hospitals. The subsidy cannot be justified on efficiency grounds, as, on the basis of available evidence and taking casemix into account, public hospitals are more efficient than private hospitals. The original stated objective of the subsidy was to "take pressure off public hospitals". If the insurance subsidy and the Medicare Benefit Schedule rebate expenditure were applied to purchasing public hospital treatment at full average cost, 58% of current private sector demand could be accommodated. If 10% of the demand were met at marginal cost, this would increase to 65%. The objective of "taking pressure off public hospitals" could be more efficiently achieved by direct funding of public hospitals rather than through subsidies for private health insurance.

Australia↗
PubMed1998

Psychiatric hospitalization characteristics associated with insurance type.

This study examines the relationship among types of insurance and characteristics of inpatient psychiatric treatment. Data include 46,998 adult psychiatric or substance abuse cases from all 1991-1992 Washington State discharges from short-stay general hospitals. Large and significant differences among payers exist in treatment characteristics, controlling for diagnosis and patient age. For example, length of stay is longest among commercial and Medicare payers. Emergency admissions are more common among public payers, and elective admissions are more common among private payers, including HMOs. Results and discussed in light of policy and administration issues that will arise as financing for mental health services comes under greater capitation.

Adult↗