Use of inpatient imaging services by persons without health insurance

Americans without health insurance generally receive fewer health care services than those with insurance. Less studied are the specific types of services for which the uninsured face access and utilization differences. This article fills in some of the knowledge gaps by presenting comparisons between uninsured and insured individuals in the use of imaging services in the hospital inpatient setting.

The primary data source for this study was the 2003 National Hospital Discharge Survey. The principal source of payment was used to define insurance status. Global relative value units were assigned by imaging procedure. To ensure sufficient numbers of observations, individual imaging procedures were aggregated into 6 modalities. Multivariate regression was used to estimate the utilization and value of imaging services as a function of insurance status and other control variables.

Just over 9% of inpatients were uninsured (range, 15.7% aged 18-24 years to 5.8% aged 55-64 years). After controlling for measurable factors, uninsured hospital inpatients who underwent imaging received the same mean number of imaging services (1.51) of the same mean value (11 relative value units) as those for comparable insured persons. The uninsured received fewer interventional and image-guided procedures but more CT studies than insured patients (P < .05).

Because insurance status does not seem to significantly influence the quantity or value of imaging services received by hospital inpatients who receive imaging, efforts to assist uninsured patients with imaging needs would be better directed elsewhere than the hospital inpatient setting.