Insurance-based Disparities in Outcomes and Extracorporeal Membrane Oxygenation Utilization for Hospitalized COVID-19...

Area of Science:

• Health Services Research
• Health Economics
• Public Health

Background:

• Examining insurance-based disparities in healthcare outcomes for COVID-19 patients.
• Assessing variations in mortality, nonhome discharges, and ECMO utilization.
• Focusing on patients hospitalized with COVID-19 in U.S. academic medical centers.

Purpose of the Study:

• To investigate insurance-based disparities in mortality, nonhome discharges, and extracorporeal membrane oxygenation (ECMO) utilization among COVID-19 patients.
• To evaluate how these disparities are affected by the type of insurance coverage and the hospital's COVID-19 patient burden.

Main Methods:

• Utilized a national database of U.S. academic medical centers and affiliated hospitals.
• Risk-adjusted analysis of mortality, nonhome discharge, and ECMO utilization based on insurance type (private, Medicare, dual, none) and hospital COVID-19 burden.
• Modeled interaction between payer status and COVID-19 burden to assess changes in disparities.

Main Results:

• Significant disparities observed: higher mortality odds for Medicare, dual-eligible, Medicaid, and uninsured patients compared to privately insured.
• Lower likelihood of ECMO utilization for Medicare, dual-eligible, Medicaid, and uninsured patients versus privately insured.
• Disparities in mortality, nonhome discharges, and ECMO use did not significantly worsen as hospital COVID-19 burden increased.

Conclusions:

• Substantial insurance-based disparities exist in COVID-19 patient outcomes, including mortality and ECMO utilization.
• These disparities did not escalate with increasing hospital COVID-19 patient load.
• Highlights the need to address systemic inequities in healthcare access and treatment for vulnerable patient populations.