Battling the uncompensated care spiral: outcomes from a single institution assisting uninsured hospitalized patients to obtain health insurance

Prof Case Manag. 2010 Sep-Oct;15(5):280-9. doi: 10.1097/NCM.0b013e3181e2d114.


Purpose of study: The purpose of this research was to evaluate the effectiveness of financial counseling services in assisting uninsured patients receive financial assistance and medical insurance.

Primary practice setting: A single, nonprofit 400+-bed, inner-city, acute care facility in the Mountain West.

Methodology and sample: A retrospective, medical record review design was used. Records for any uninsured patients admitted as inpatients to the hospital were considered for the study. A sample of 50 records was selected by evaluating every 21st patient from a chronological list of 1,070 possible records of all uninsured patients admitted to the facility during the months of May through July 2006. A tool was created for this study and used by the principal investigator (H.B.) to abstract specific points of data from each patient record. The research was approved by the university institutional review board. Descriptive statistical analyses were then performed to determine trends.

Results: Financial counseling at this institution aided 55% of uninsured patients to obtain health insurance. Because insurance was obtained for previously uninsured patients, the institution was reimbursed a total of $865,350. The institution was left with a total of $388,291 in uncompensated care. Patients younger than 18 years and patients admitted to labor and delivery or newborn nursery units obtained insurance coverage more often than other patients.

Implications for case management practice: Insurance counseling for uninsured hospital patients has proven to be effective. The patient benefits from the counseling by obtaining insurance and the hospital benefits by receiving more financial reimbursement for services given. Case managers have a great opportunity to help their uninsured patients by offering insurance counseling. Case managers should familiarize themselves with all possible health insurance options so that they can advise and guide patients through these application processes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Compensation and Redress*
  • Female
  • Health Care Reform
  • Hospitalization / economics*
  • Hospitalization / statistics & numerical data
  • Humans
  • Insurance Coverage / economics
  • Insurance Coverage / statistics & numerical data
  • Insurance, Health / economics*
  • Insurance, Health / statistics & numerical data
  • Insurance, Health, Reimbursement
  • Length of Stay
  • Male
  • Medically Uninsured / statistics & numerical data*
  • Middle Aged
  • Outcome Assessment, Health Care / economics*
  • Retrospective Studies
  • United States
  • Young Adult