DOES INSURANCE TYPE MATTER? AN EMPIRICAL ANALYSIS OF THE EFFECT OF INSURANCE TYPE ON MEDICAL CARE QUALITY IN THE UNITED STATES

Abstract

Despite spending the most per capita on health care, the United States does not measure up to other industrialized countries on a range of health quality indicators. Medical care is one factor among many contributing to the health of a country, and a considerable body of research points to various factors underlying medical care quality. This study examines the extent to which a patient’s type of insurance plays a role in determining the quality of hospital care received. We use a general model accounting for both patient and hospital characteristics, and then a fixed-effects model to isolate withinhospital sorting. The data for this study came from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) in 2011. We examine five expensive and prevalent medical conditions and procedures in the United States: craniotomy, stroke, pneumonia, acute myocardial infarction (AMI), and GI hemorrhage. Results suggest that uninsured patients have higher mortality odds ratios compared to privately insured patients for two out of the five medical procedures studied: craniotomy and stroke. For GI hemorrhage, Medicaid patients have heightened odds of in-hospital death compared to the privately insured. Length of stay is increased for both Medicaid and uninsured patients compared to privately insured patients for all five conditions examined. The hospital fixed-effects models reveal similar results. These findings suggest that access (between-hospital sorting) and varying treatment practices within hospitals contribute to health outcome disparities on certain medical conditions. Further research is needed to confirm the affected conditions, so that policy-makers can address access disparities and hospitals can monitor and tackle differences in treatment practices within hospitals