JACR: Insurance status doesnt affect inpatient imaging access

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Insurance status doesn’t affect the quantity or value of imaging services received by patients in a hospital in-patient setting, according to a study appearing in the January issue of the Journal of the American College of Radiology (JACR).

Kimberly E. Applegate, MD, MS, of Emory University School of Medicine in Atlanta, and James W. Moser, PhD, of Econometrica, a private research and management consulting firm in Bethesda, Md., wrote that approximately 51 million Americans are uninsured and while it is known that uninsured Americans generally receive fewer healthcare services, what’s less understood is the specific types of services with reduced access for the uninsured.

For the current study, Applegate and Moser were concerned with imaging services received in an inpatient hospital setting.

Using data from the 2003 National Hospital Discharge Survey, the researchers looked at the type of payment used by patients to define insurance status and assigned relative value units (RVUs) to the imaging procedures performed.

Results showed that just over 9 percent of inpatients were uninsured. After controlling for measurable factors, uninsured hospital inpatients who underwent imaging received the same number of imaging services as insured inpatients with the average being 1.51 imaging services per inpatient. The total value of the services received measured 11 RVUs per discharge and there was no statistically significant difference in the value of services between insured and uninsured inpatients.

“Because insurance status does not seem to significantly influence the quantity or value of imaging services received by hospital inpatients, efforts to assist uninsured patients with imaging needs would be better directed elsewhere than the hospital inpatient setting,” said Applegate.

While the total number of procedures and value was roughly the same, differences emerged when the types of services were broken down by modality. The uninsured received fewer interventional and image-guided procedures; however, they received more CT studies than insured patients.

Applegate and Moser also looked at the level of imaging services received by insured and uninsured patients in the emergency department (ED) setting in a separate study published in the January issue of JACR. That study found insurance status can influence care as uninsured and Medicaid patients received fewer imaging services in the ED than the insured.