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Ability to Pay Drives Hospital Length of Stay

John Commins, for HealthLeaders Media, November 21, 2011

Uninsured patients spend less time in the hospital than insured patients, according to a study that suggests that ability to pay plays a greater role than medical need when determining length of stay.

"The only two explanations we could come up with are either people without insurance are being discharged prematurely or hospitals are keeping people who can pay longer to increase revenue," Arch G. Mainous, III, the author of the study, told HealthLeaders Media.

The study, published in the December issue of Annals of Family Medicine, examined nearly 850,000 adult discharges between 2003 and 2007, at for-profit, non-profit, and government hospitals nationwide. The findings show that in hospitalizations for ambulatory care-sensitive conditions – which should have been avoidable through disease management and preventive care -- uninsured patients stayed an average of 2.8 days.

Privately insured patients stayed an average of 2.9 days, and Medicaid patients averaged 3.2 days. For patients hospitalized with non-ACSCs, the average length of stay averaged 2.7 days for the uninsured, compared with 2.8 days for the privately insured, and 3.1 days for Medicaid patients.

"We have relatively robust findings that appear over and over that people without insurance, regardless of what they come in for, stay a shorter period of time, even on things where they might be sicker," says Mainous, a researcher with the Department of Family Medicine at the Medical University of South Carolina, in Charleston.

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