| OCR Text |
Show Health Insurance and ACS Hospitalization Rates Insurance coverage is one means of overcoming economic barriers to access to primary care (Newacheck, Stoddard, & Hughes, 1998). Thus, one might ask whether ACS hospitalization rates differ in countries with and without national health insurance. Table 1 displays Utah rates of specific types of ACS hospitalizations in children, pooled over the years 1992-1995. They have been standardized to the U.S. 1988 age and sex distribution in order to compare them to rates provided by Casanova and Starfield in several American locations and Valencia, Spain. For example, the rate of child hospitalizations for asthma in Utah during 1992-1995 would have been 12.1 per 10,000 children, if Utah children had the same age and sex distribution as all U.S. children in 1988. The U.S. child asthma hospitalization rate in 1988 was 30.9 per 10,000 children. Because of the sparsity of the Utah population, particularly in the rural and frontier counties, four years of hospitalizations have been pooled to stabilize the estimated Utah rates. Not all Utah ACS hospitalization rates are displayed. The standardized all-ACS hospitalization rate for children age 0-15 in Utah is 67.0 hospitalizations per ten-thousand children per year. Utah child hospitalizations for bacterial pneumonia, asthma, and dehydration encompass over half the ACS hospitalizations of Utah children between 1992-1995. Child hospitalizations for immunizable conditions, failure to thrive, hypoglycemia, iron deficiency, nutritional deficiencies, tuberculosis, and congenital syphilis would be important if they occurred, but all are of low frequency. Rural Utah rates of child hospitalization for bacterial pneumonia in 1992-1995 are elevated compared to urban rates. Asthma hospitalization rates exhibit significant variability across Utah counties, but they are elevated in urban children. Child hospitalizations for diabetes show no significant variability across Utah counties in children. Cellulitis hospitalizations show significant variability across Utah counties, but no rural-urban differences. A year-by year analysis suggests that no substantial secular trends in these rates occurred over the period of 1992-1995, so that it is probably reasonable to compare them to the rates published by Casanova and Starfield, which were studied prior to the availability of computerized hospital discharge data in Utah3 (data not shown). 3 Data available from the author upon request. The Utah rates are generally higher than those of the Valencia, Spain health district in 1989-1990. This health district includes 51 towns and 25,777 children ages 0-15. It is served by Sagunto General Hospital. Spain has national health insurance. Casanova and Starfield reported that child hospitalization rates were not associated with socioeconomic status in this region (Casanova & Starfield, 1995). This is similar to a finding by Billings that ACS hospitalizations in the general Canadian population, which has national health insurance, are not as strongly correlated with local socioeconomic status as are American ACS hospitalization rates (Billings et al., 1996). Billings has also demonstrated the responsiveness of New York City ACS hospitalization rates to program initiation and termination. Utah CHIP and ACS Hospitalization Rates The Utah CHIP provides insurance coverage. Therefore, it can be expected to lower some of the economic barriers of children to access to primary care (Newacheck et al., 1998) and hence reduce child ACS hospitalizations. Billings estimated that in an adult population, in the District of Columbia, medically preventable or avoidable admissions constituted 39.4% of admissions in uninsured patients, 21.2% of admissions in Medicaid patients, and 12.2% of (Weinberger, Oddone, & Henderson, 1996) admissions in privately insured patients (Billings & Teicholz, 1990). This suggests that the CHIP hospitalization rates might be comparable to current Medicaid rates. Thus, overall Utah child ACS hospitalization rates would be anticipated to drop to the degree that currently uninsured children's hospitalization rates drop to Medicaid levels. One ACS condition which already plays a role in the proposed CHIP evaluation concerns the rate of hospital readmission for asthma (Leavitt & Betit, 1998). Whether health benefits in terms of decreased hospitalization would be seen in the first year of CHIP is unclear. Primary care entails a long-term relationship between a clinician and a patient, and sometimes good primary care includes hospitalization, particularly when that relationship is new (Weinberger et al., 1996). Appropriate response to children who have previously been medically underserved might temporarily increase their use of medical services. Since CHIP evaluations are planned annually, this phenomenon would be observable. Although some reduction in hospitalizations for chronic conditions may be observed early, it is 53 |
