Under-Insured Children at High Risk In Colorado
from Practice Update, Winter 2005
By James Todd, MD, Jules Ame Chair in Community Pediatrics, The Children’s Hospital, Professor of Pediatrics, Microbiology and Preventative Medicine/Biometrics, UCHSCCarl Armon, MSPH, Research AssociateStephen Berman, MD, Professor of Pediatrics, Section Head Academic General Pediatrics, Director, Children’s Outcomes Research Program
Table 1: Total hospitalization charges for Colorado
children ages > 28 days to < 18 years per insured
population by insurance type and year.
There has been a gradual decrease since 1995 of children in Colorado covered by private health insurance. We have recently documented that inadequate primary care and lack of age-appropriate immunizations are associated with an increasing proportion of Medicaid enrolled children not having an assigned primary care physician. There has also been an erosion of willingness of primary care physicians in private practice to participate in Medicaid related to payments that fail to cover visit overhead costs and administrative inefficiencies. Similarly, The Children’s Hospital is the largest provider of Medicaid care for hospitalized children in Colorado, but reimbursement does not cover costs.
The failure of state child health policies to encourage a medical home may actually increase healthcare expenditures because of higher than expected preventable hospitalization rates. We have completed a population-based analysis of hospitalization data for children from the Colorado Hospital Association database from 1995-2003 using health insurance coverage estimates from the U.S. Census Bureau.
The results show that children with public or no insurance have much higher hospital charges and significantly higher hospitalization rates overall, as well as higher admission rates for children with chronic illness, asthma, diabetes, appendectomy and vaccine-preventable disease. Table 1 shows the per capita hospital charges for children with public or no insurance as compared to private insurance. In aggregate, there was an excess of charges of over $34 million in 2003. Since they often don’t have a medical home, these children were admitted from the Emergency Department. In addition, children with public or no insurance had higher fatality rates, a higher severity of illness and a higher proportion with complications such as a ruptured appendix.
These findings document substantially greater hospital charges and morbidity for children with public or no insurance. They also suggest the opportunity for improved health outcomes and decreased costs for underinsured children if private insurance standards of medical home and hospital care could be achieved that would offer more consistent prevention and acute care within a continuity setting.
In the current situation everyone loses: the Medicaid/CHIP patients and families who experience excessive mortality and morbidity, community-based physicians and hospitals who aren’t compensated enough to cover costs, the business community who pay more to providers to cover at least part of the Medicaid shortfall and the Colorado tax payers who pay for these public health plans that are not getting the best value (outcomes) for the dollar. The implication is that the $34 million could be better spent by providing improved primary care that reduces the need for emergency visits and hospitalization.
