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The effect of insurance status on likelihood of neonatal interhospital transfer
D R Durbin1, A P Giardino, K N Shaw
1Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19014, USA.
Insights
Uninsured and Medicaid-covered neonates were more likely to be transferred between hospitals than privately insured infants. This suggests financially motivated transfers may impact neonatal care access.
Area of Science:
- Neonatal care
- Health services research
- Health economics
Background:
- Insurance status significantly influences healthcare access and utilization.
- Previous studies indicate financially motivated interhospital transfers in adult populations.
- The impact of insurance on neonatal interhospital transfers requires further investigation.
Purpose of the Study:
- To examine the association between insurance status and the likelihood of interhospital transfer for neonates.
- To determine if uninsured or publicly insured neonates are more prone to transfer compared to privately insured neonates.
Main Methods:
- Population-based retrospective cohort study.
- Analysis of 56,789 infants (0-28 days) admitted to or born in southeastern Pennsylvania hospitals in 1991.
- Outcome measure: transfer to another general or specialty acute care hospital.
Main Results:
- Interhospital transfer incidence was 1.69%.
- Uninsured neonates had nearly double the likelihood of transfer (RR=1.96) compared to commercially insured infants, even after adjusting for prematurity and illness severity.
- Medicaid-enrolled neonates also showed a higher likelihood of transfer (RR=1.20) than commercially insured infants.
Conclusions:
- Neonates lacking insurance or covered by Medicaid were more likely to be transferred than those with private insurance.
- Findings suggest financially motivated transfers may be occurring within neonatal care systems.
- This study provides evidence of such phenomena in a pediatric population, consistent with adult and maternal transfer studies.
Objective:
To determine the effect of insurance status on the likelihood of interhospital transfer for neonates.
Design:
Population-based retrospective cohort study.
Setting:
All general acute care nonpediatric hospitals in the five counties of southeastern Pennsylvania.
Patients:
Fifty-six thousand, seven hundred eighty-nine infants from 0 to 28 days of age admitted to or born in study hospitals between January 1 and December 31, 1991.
Intervention:
None. MAINS OUTCOME MEASURE: Transfer to another general or specialty acute care hospital.
Results:
The incidence (95% confidence interval) of interhospital transfer was 1.69% (1.60, 1.78). Uninsured infants were nearly twice as likely [relative risk (RR) = 1.96 (1.67, 2.31)] to be transferred as commercially insured infants, even when adjusted for the effects of prematurity, severity of illness, and the level of neonatal intensive care unit in the referring hospital. Similarly, infants with Medicaid were more likely to be transferred [RR = 1.20 (1.01, 1.43)] than similar commercially insured neonates. Uninsured and publicly insured infants were also more likely to be born premature [RR 1.49 (1.39, 1. 60)] than privately insured neonates, and were more likely to have both moderate [RR 1.11 (1.04, 1.23)] and high [RR 1.21 (1.11, 1.32)] illness severity on admission to the hospital than privately insured infants.
Conclusions:
Neonates with no insurance and those with Medicaid coverage were more likely to be transferred than infants with private insurance. These results are consistent with those of other investigators who have studied financially motivated patient transfers- so-called patient dumping-in nonpediatric populations of patients. Our study may represent the first documentation of this phenomenon in a pediatric population. Our results are also consistent with those of other investigators who have examined the effect of insurance status on maternal interhospital transfer, thus providing further evidence for the existence of financially motivated transfers within regional systems of perinatal care. Future investigation into the effect of economic factors on variation in the utilization of transport services, and on how transfer influences ultimate patient outcome, is needed as managed care health systems become more widespread.