Comparison of uninsured and privately insured hospital patients. Condition on admission, resource use, and outcome

JAMA. 1991 Jan 16;265(3):374-9.


To investigate the association between insurance status and condition on admission, resource use, and in-hospital mortality, we analyzed discharge abstracts for 592,598 patients hospitalized in 1987 in a national sample of hospitals. In 13 of 16 age-sex-race-specific cohorts, the uninsured had a 44% to 124% higher risk of in-hospital mortality at the time of admission than did the privately insured. After controlling for this difference, the actual in-hospital death rate was 1.2 to 3.2 times higher among uninsured patients in 11 of 16 cohorts. The uninsured also were 29% to 75% less likely to undergo each of five high-cost or high-discretion procedures and 50% less likely to have normal results on tissue pathology reports for biopsies performed during five of seven different endoscopic procedures. Our results suggest that insurance status is associated with a broad spectrum of aspects of hospital care.

KIE: The authors of this study sought to identify whether there are statistically significant differences between uninsured patients and those with private insurance in three sets of factors related to hospital care: are the uninsured sicker when admitted to the hospital; are fewer resources used in their hospital care, given their condition upon admission; and, given their admission condition, do they have poorer outcomes? Statistical analyses were performed on a data file of 592,598 discharge abstracts selected from over 10 million discharge abstracts for 1987 submitted to the Commission on Professional and Hospital Activities. Analysis of the data suggested to Hadley, et al. that an individual's condition on admission to the hospital, use of resources during hospitalization, and likelihood of in-hospital death vary depending on whether the individual has health insurance.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Female
  • Hospitals / statistics & numerical data*
  • Humans
  • Infant
  • Insurance, Hospitalization / statistics & numerical data*
  • Length of Stay / statistics & numerical data
  • Male
  • Medical Indigency / statistics & numerical data*
  • Middle Aged
  • Mortality
  • Patient Admission / statistics & numerical data
  • Patient Selection*
  • Probability
  • Radiography / statistics & numerical data
  • Regression Analysis
  • Resource Allocation
  • Surgical Procedures, Operative / statistics & numerical data
  • United States
  • Utilization Review