Estimates of Hawai`i’s Uninsured from Hospital Emergency Department & Inpatient Data—the Latest Update The Hawaii Coverage for All Project Technical Workshop VIII January 30, 2006 Susan Forbes, DrPH Jill Miyamura, PhD Hawaii Health Information Corporation

Why does ED and hospital data matter? Extensive literature on the inferior health status of the uninsured Extensive literature on the negative impact that lack of insurance has on the stability of the health system Evidence that the uninsured use the ED for primary care Provides yet another view of the issues involved

Data Sources Data submitted monthly by hospitals to Hawaii Health Information Corporation All emergency departments except Tripler, Kahuku and Molokai All acute care hospitals (inpatient data)

Uninsured ED Visits

Uninsured ED Visits by Sex

Uninsured ED Visits by Sex and Age, 2004

Uninsured ED Visits by Island

Top 10 Reasons for ED Visit by Insured Status, 2002 Infectious Disease and Dental were not one of the top ten reasons for ER visits in 2002 for the insured. Similarly, General medicine is much higher for the uninsured than the insured. This suggests that the uninsured may be using EDs for primary care.

Top 10 Reasons for ED Visit by Insured Status, 2004 Dermatology, General medicine, Psychiatry, Infectious Disease higher for the uninsured than the insured.

Inpatient Admissions from ED by Status When admitted to the Inpatient, people that may not have had insurance are found to see if they qualify for insurance under QUEST. One of the reasons the IP records show a very low uninsured rate.

Top 10 Reasons for Admission from ER by Insured Status Once people are admitted into the inpatient setting, the reasons for being admitted become similar, further suggesting that the uninsured may use EDs for primary care. 2004

Preventable Hospitalization by Insurance Status For 0-64 only. Does not include low birth weight.

Preventable Hospitalizations by Payer For 0-64 only. Does not include low birth weight.

Preventable Hospitalizations Charges by Payer For 0-64 only. Does not include low birth weight.

Preventable Hospitalizations ALOS by Payer For 0-64 only. Does not include low birth weight.

Preventable Hospitalizations by County For 0-64 only. Does not include low birth weight.

Preventable Hospitalizations by County and Insured Status For 0-64 only. Does not include low birth weight.

ED Charge per Visit by Insured Status

ED Charge per Visit by Payer Uninsured burden to hospitals—In 2002, the charges to the uninsured were over $50 million for inpatient and ED combined.

Burden to the Hospitals In 2004, charges to the uninsured were over $64 million for ED and inpatient combined

Top Reasons for ED Infectious Disease Diagnosis Insured Uninsured Cellulitis 68% 81% Viral Illness 23% 13% Over80 percent of uninsured visits are for cellulitis, an ambulatory care sensitive condition.

Top Reasons for ED Psychiatry Diagnosis Insured Uninsured Alcohol or Drug Abuse 28% 46% Acute Anxiety 24% 17% Over seventy percent of uninsured visits are for cellulitis, an ambulatory care sensitive condition.

Top Reasons for ED General Medicine Diagnosis Insured Uninsured Sign & Symptoms Influencing Health Status 42% 51% Toxic Effects of Non-Medicinal Substances 14% 12% Over seventy percent of uninsured visits are for cellulitis, an ambulatory care sensitive condition.

Questions? Susan Forbes 534-1277 sforbes@hhic.org MAHALO!!!