James Moser PhD, Presenter: Nothing to Disclose

Kimberly E. Applegate MD, MS, Abstract Co-Author: Contract, Springer Science+Business Media Deutschland GmbH

Americans without health insurance generally receive fewer health care services than those with insurance do. 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 is the 2003 National Hospital Discharge Survey. Principal source of payment was used to define insurance status. Relative Value Units (RVUs) were assigned by imaging procedure. To ensure sufficient numbers of observations, individual imaging procedures were aggregated into seven modalities. Multivariate regression was used to estimate the utilization and value of imaging services as a function of insurance status and other control variables.

Uninsured hospital inpatients receive fewer and lower-valued services than those for comparable insured persons. The uninsured received approximately 12% fewer imaging RVUs than insured persons did, mainly because the uninsured received a greater concentration of lower-valued imaging procedures and a lower concentration of higher-valued procedures.

Numerous explanations, interpretations, and questions can be drawn regarding the utilization differences between uninsured and insured persons. Do uninsureds get too few services, or insureds too many? How aware are service providers of patients’ insurance status, and how might such knowledge enter into their diagnosis and treatment decisions? Policy recommendations are made to address uninsured access and use deficits that have potential health consequences.

Radiologisits and other physicians attending hospital inpatients who note that they are insured should consider whether such patients are receiving the best imaging services for their needs.

Moser, J, Applegate, K, Use of Imaging Services by Uninsured Hospital Inpatients.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6022194.html