Admission severity of illness and resource utilization: comparing Medicaid and privately insured patients.

Abstract

This study compares Medicaid patients and privately insured patients. Regression analyses examine the effect of Medicaid status on hospital admission severity, length of stay, and ancillary charges for 14,557 patients in ten medical DRGs and ten surgical procedures. The results show that Medicaid patients were significantly sicker on admission, especially the medical patients. After adjustments for patient age and sex, admission severity of illness, case mix, and hospital, Medicaid patients still had significantly longer lengths of stay and higher ancillary charges, although the effect was not as strong for ancillary charges. We suggest that this association between Medicaid status and length of stay and ancillary charges may be due to greater difficulty in discharge planning for Medicaid patients, health status differences not captured adequately in severity classification, and utilization review practices. The implications of these findings for hospital management, health care policy, and future research are discussed.