ABSTRACT
CONTEXT: Few data at the level of local health jurisdictions are available to characterize health problems specific to persons without health insurance. PRACTICE PATTERN EXAMINED: Hospitalization patterns of residents of DeKalb County, Georgia, who have no health insurance. DATA SOURCE: 1996 Georgia hospital discharge records for persons living within ZIP code areas included in or overlapping with DeKalb County. RESULTS: Of 67,156 hospital discharges, 6781 (10%) were for uninsured patients. Sixty-eight percent of uninsured hospitalizations took place in publicly owned and controlled hospitals, where uninsured persons represented 45% of all discharges. Charges associated with uninsured hospitalizations amounted to $51.3 million in 1996, of which $35.3 million (69%) was claimed by public hospitals. The uninsured were overrepresented in many diagnostic groups, including diabetes, injury and poisoning, chronic liver disease, skin disease, and infectious or parasitic disease. CONCLUSIONS: In DeKalb County, Georgia, the burden of uninsured hospitalizations falls disproportionately on the public sector. Policy initiatives are needed to more equitably share the burden of uninsured hospitalization with for-profit hospitals. Because the uninsured were overrepresented in several conditions, public health initiatives aimed at preventing these conditions should also be a priority.
Subject(s)
Hospitals, Public/statistics & numerical data , Insurance Coverage/statistics & numerical data , Medically Uninsured/statistics & numerical data , Adolescent , Adult , Age Distribution , Aged , Cost of Illness , Female , Georgia/epidemiology , Health Care Surveys/methods , Health Expenditures , Hospitals, Public/economics , Humans , Infant , Infant, Newborn , Middle Aged , Morbidity , State Health Planning and Development Agencies , United States , Urban Health/statistics & numerical dataABSTRACT
National data sets are often insufficient for priority setting by local public health systems and the communities they serve. We used marketing data to conduct an ecological analysis of hospital discharge rates in DeKalb County, Georgia, during 1996. Persons living in poorer areas had significantly higher discharge rates for the following conditions: hypertensive disease, blood-related conditions, pneumonia/influenza, diabetes, and chronic obstructive pulmonary diseases. Local marketing data helped identify conditions associated with higher hospital utilization in poorer areas of this urban county. This identification of priority issues informs plans for behavior modification, access to primary care and a healthy environment.
