The burdens of uninsured hospitalizations in an urban county

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.