1 / 15

James Kirby AHRQ

Community Uninsurance Rates and Expenditures on Emergency Room Care: Is there Evidence of a Spillover?. James Kirby AHRQ. What is “Spillover”?. The number of uninsured people in a community may affect medical care for everyone, even those with health insurance. Why Might Spillover Occur?.

fritz
Download Presentation

James Kirby AHRQ

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Community Uninsurance Rates and Expenditures on Emergency Room Care: Is there Evidence of a Spillover? James Kirby AHRQ

  2. What is “Spillover”? • The number of uninsured people in a community may affect medical care for everyone, even those with health insurance

  3. Why Might Spillover Occur? • A large number of uninsured residents may: • provide a less stable revenue base for providers • result in high levels of uncompensated care

  4. Literature • Previous literature focuses on access • Spillover to cost is not examined • Spillover in the context of emergency rooms is not examined

  5. Research Questions • Do insured individuals living in areas with many uninsured people pay more for emergency room care? • How does this differ by insurance type?

  6. Data Sources • Individual-level data: Medical Expenditure Panel Survey, 2009 • Adults with at least one emergency room visit who live in a county with 65,000 residents or more (N=3,773) • County-level data: American Community Survey, 2009

  7. Main Variables • Main Outcome variable • Average expenditure per emergency room visit • Main Independent variables • County-level: Number of uninsured individuals per emergency room • Individual-level: Insurance status

  8. Control Variables Individual-level County-level Poverty rate Unemployment rate Number of Federally Qualified Health Centers (FQHC) per capita MSA vs non-MSA • Race/ethnicity • Sex • Age • Subjective health • Serious chronic conditions • Poverty status

  9. Methods • Generalized Linear Model • Family: Gamma • Link: Log • Marginal predictions in dollars

  10. Means of Main Variables

  11. Marginal Predictions for Per-Visit Emergency Room Expenditure, All Adults

  12. Marginal Predictions for Per-Visit Emergency Room Expenditure, All Adults

  13. Marginal Predictions for Per-visit Emergency Room Expenditure

  14. Summary & Conclusion • The number of uninsured people per ED in a county is positively associated with average expenditures per ED visit • This association exists only among insured individuals • The association is strongest among those with public insurance • Reducing the number of uninsured people in communities may lower ED expenditures for the insured, but especially for those with public insurance

  15. Limitations • Unobserved differences in intensity of use? • Unobserved differences in county characteristics?

More Related