The number of patients who left a U.S. hospital against medical advice rose by 40%, or 105,000 discharges, between 1997 and 2008, the second fastest increase of any discharge category, according to statistics released by the federal Agency for Healthcare Research and Quality.
Uninsured and Medicaid stays in 2008 accounted for nearly half (48%) of all patients who left hospital inpatient care against medical advice, but they made up only 23% of all patient stays, indicating that uninsured and Medicaid patients were more likely than the general hospital inpatient population to leave against medical advice.
Private insurance was the primary payer for 35% of all stays, but only 20% of discharges against medical advice while Medicare paid for 37% of all stays, but only 27% of Medicare patients left against medical device.
The report did not elaborate on why patients covered by Medicaid and the uninsured seem more likely to risk leaving the hospital than those patients covered by other payment sources. It noted, however, that the percentage of patients in 2008 who left against medical advice overall was relatively small, about 370,000 discharges, even though it did have the second fastest percentage increase over that 10 year period.
According to Stephen W. Hwang, MD,a research scientist at the Centre for Research on Inner City Health at St. Michael's Hospital in Toronto, factors associated with leaving against medical advice include people uninsured or on Medicaid, admission through the ED, admission with a substance abuse-related diagnosis. Leaving against medical advice, he wrote on a commentary on the AHRQ website was "three times more likely to occur on days when welfare checks were issued."
"Patients leave AMA for a variety of reasons. When asked, they most commonly cite family problems or emergencies; personal or financial obligations; feeling bored, fed up, or well enough to leave; or dissatisfaction with their treatment. Although many patients who discharge themselves AMA have substance abuse problems, few of them attribute their decision to leave to their addiction," Hwang wrote.
The fastest increase in discharges was the category of patients who went to follow-on care. In that category, the percentage discharged to home health care services grew by 69% in this period. That equated to 1.6 million discharges. Discharges to nursing homes and long-term care increased by 35%, or by 1.33 million discharges.
The number of discharges for in-hospital deaths declined 5% and discharges (transfers) to another short-term hospital rose 4%.
In 2008, the lion's share of discharges from U.S. hospitals involved patients who had routine discharges to their homes without closely supervised follow up healthcare. That category amounted to 72% of 39.9 million discharges.
The second largest category of discharges was to long-term care and other facilities, 13%. The third was to home health care services, 10%. In-hospital deaths and discharge to another short-term hospital were each 2% of discharges.
The AHRQ statistics may be found here.