Inpatient Hospitalization Costs: A Comparative Study of Micronesians, Native Hawaiians, Japanese, and Whites in Hawai'i

Abstract

Considerable interest exists in health care costs for the growing Micronesian population in the United States (US) due to their significant health care needs, poor average socioeconomic status, and unique immigration status, which impacts their access to public health care coverage. Using Hawai'i statewide impatient data from 2010 to 2012 for Micronesians, whites, Japanese, and Native Hawaiians (N = 162,152 hospitalizations), we compared inpatient hospital costs across racial/ethnic groups using multivariable models including age, gender, payer, residence location, and severity of illness (SOI). We also examined total inpatient hospital costs of Micronesians generally and for Medicaid specifically. Costs were estimated using standard cost-to-charge metrics overall and within nine major disease categories determined by All Patient Refined Diagnosis Related Groups. Micronesians had higher unadjusted hospitalization costs overall and specifically within several disease categories (including infectious and heart diseases). Higher SOI in Micronesians explained some, but not all, of these higher costs. The total cost of the 3486 Micronesian hospitalizations in the three-year study period was $58.1 million and 75% was covered by Medicaid; 23% of Native Hawaiian, 3% of Japanese, and 15% of white hospitalizations costs were covered by Medicaid. These findings may be of particular interests to hospitals, Medicaid programs, and policy makers.

Keywords: Micronesians; Pacific Islander; costs; health equity; hospitalization.

Figure 1

Total Costs (in Millions) for Micronesian hospitalizations by Medicaid vs. Not Medicaid by All Patient Refined Diagnosis Related Groups hospitalization types from 2010 to 2012 Hawaii Health Information Corporation Data. The amount paid by Medicaid for each type is noted. (n = 3486 Micronesian hospitalizations). Specific percentages as paid by Medicaid by disease type are as follows: 75% Cancer, 44% Skin, 74% Dental, 75% Infectious, 73% Mental Health, 72% Substance Use, 90% Endocrine, 80% Heart Disease, and 76% Pulmonary.

Figure 2

Median Costs in US Dollars by All Patient Refined Diagnosis Related Groups hospitalization-related types from 2010 to 2012 Hawaii Health Information Corporation Data. Cardiac, pulmonary, infectious, and mental health racial/ethnic comparisons were significant at p < 0.001. Substance abuse was significant at p < 0.01. (n = 69,449 unique individuals, at first visit). Comparisons by race were as follows, cancer (p = 0.15), endocrine (p = 0.07), cardiac (p < 0.001), pulmonary (p < 0.001), infectious (p < 0.001), mental health (p < 0.001), substance use (p = 0.004), skin (p = 0.36), and dental (p = 0.73).

Figure 3

Median Costs in US Dollars by Race/Ethnicity and Severity of Illness Levels (Minor, Moderate, Major, Extreme) from 2010 to 2012 Hawaii Health Information Corporation Data. All four within-SOI-level racial/ethnic comparisons were significant at p < 0.001. (n = 162,152). Please note: The 3M Severity of Illness (SOI) score ranges from minor (1) to extreme (4) and is designed to be specifically used within APR-DRG disease categories. “Overall” SOI may thus not be a meaningful metric. Use of this overall metric here allows for a broad comparison of costs by SOI level for studying racial/ethnic groups, but these caveats should be considered.