PEDIATRICS
August 2006
ABSTRACT. Increased Rates of Morbidity, Mortality, and Charges for Hospitalized Children With Public or No Health Insurance as Compared With Children With Private Insurance in Colorado and the United States By James Todd, MD, Carl Armon, MSPH, Anne Griggs, MSPH, Steven Poole, MD and Stephen Berman, MD
BACKGROUND. There has been a gradual decrease in the proportion of children covered by private health insurance in Colorado and the United States with a commensurate increase in those with public insurance or having no insurance which may impact access to care and outcomes.
OBJECTIVE. The purpose of this work was to determine whether children with public or no health insurance have differences in hospital admission rates, morbidity, mortality, and/or charges that might be improved if standards of primary care comparable to those of children with private insurance could be achieved.
METHODS. We conducted a retrospective comparison of hospitalization-related outcomes for children <18 years of age in Colorado from 1995-2003 and in the United States in 2000. Population-based rates for hospital admission were determined stratified by age, race/ethnicity, disease grouping, and health insurance status. RESULTS. Compared with those with private insurance, children in Colorado and the United States with public or no insurance have significantly higher rates of total hospital admission, as well as admission for chronic illness, asthma, diabetes, vaccine-preventable disease, psychiatric disease, and ruptured appendix. These children have higher mortality rates, higher severity of illness, are more likely to be admitted through the emergency department and have significantly higher hospital charges per insured child. Higher hospitalization rates occur in children who are nonwhite and/or Hispanic and those who are younger. If children with public or no health insurance in the United States in 2000 had the same hospitalization outcomes as children with private insurance, $5.3 billion in hospital charges could have been saved. CONCLUSIONS. There is an opportunity to achieve improved health outcomes and decreased hospitalization costs for children with public or no health insurance if private insurance standards of health care could be achieved for all US children. http://pediatrics.aappublications.org/cgi/content/abstract/118/2/577
And…
Doctor visits save dollars, kids’ lives
DenverPost.com
08/07/2006
Regular visits to the doctor by children on Medicaid or with no insurance could prevent serious illnesses and hospitalizations – saving state taxpayers $46 million, according to a study by two Denver pediatricians.
The study found the death rate for those children was almost double that of children with private insurance.
“What this shows is, if you don’t give children a medical home, they end up in the emergency department or the hospital,” (coauthor James) Todd said.
“That costs more, in dollars and also in morbidity and mortality,” he said.
In 2004, the two doctors surveyed colleagues across the state and found the number of pediatricians willing to treat Medicaid patients had dropped by almost half, from 41.4 percent in 2000, to 23.9 percent in 2003.
At that time, 83 percent of the doctors surveyed said Medicaid payments don’t cover their costs of seeing patients.
http://www.denverpost.com/news/ci_4144600
Comment:
By Don McCanne, M.D.
Reading the entire Abstract leads you to one unmistakable conclusion: children covered by private insurance have lower death rates and lower costs than do children covered by public insurance, which is the equivalent of having no insurance at all.
Whoever wrote this Abstract must be on the dole from AHIP (America’s Health Insurance Plans) since it is tantamount to an endorsement of private insurance without providing a hint at the real issues involved. Whether the insurance is public or private has nothing to do with the tragic outcomes described.
Medicaid in Colorado (and many other states) is a disaster, not because it is a public program, but because it is a welfare program that is severely underfunded because it serves a population without a political voice. Asking physicians to not only donate their services but to also pay the deficit in overhead expenses is not realistic. The margin of profit for other patients has been squeezed to the point that cost shifting is no longer an adequate option. Physicians have no other choice but to limit their exposure to Medicaid losses.
This leads to the real reason that Colorado has tragic outcomes in its Medicaid program. These children lack a medical home. Primary care is very effective in improving outcomes and lowering costs, but Colorado’s Medicaid program is impairing access to pediatricians and family physicians. Impaired outcomes, including death, is the consequence of the neglect by the public stewards of the Medicaid program.
The private insurers cannot claim that they have some marketplace magic that saves lives and reduces costs. Private insurers waste money, diverting resources away from patient care. Worse, they make every effort to avoid covering those with the greatest needs, and they are making health care less affordable by shifting more costs to those with needs. It is absolutely outrageous that the conclusion in this Abstract implies that “private insurance standards” should be achieved for all children. The standards that really should be achieved are those of a well-funded public program: universal, comprehensive, high quality, efficient, accessible, and affordable.
The editors of PEDIATRICS are guilty of journalistic malpractice.