When I worked at an urban hospital many years ago, we had a saying for the people who presented to the emergency room with violent injuries. We called them the “knife and gun club.” They represented people whose lifestyle was more dangerous than yours or mine. They rarely had health insurance and created sizable uncollectable debts. A Kaiser Family Foundation (KFF) Health News analysis found that one-quarter of gunshot victims were uninsured, at least in Florida. Furthermore, uninsured gunshot victims have hospital stays that were shorter than those covered by some type of health insurance. The following is from KFF Health News:
Uninsured gunshot victims had hospital stays of about six days on average, only three-quarters of the time spent by patients with private insurance and less than half the average stay for patients on traditional Medicaid, the public health insurance program for poor and disabled people.
KFF Health News also found that gunshot victims are undesirable customers.
Patient outreach workers say hospital personnel might perceive gunshot victims as gang members or troublemakers who deserve blame for getting shot. One study found rehab centers refuse to admit gunshot victims more often than other patients, and some medical records from hospitals were littered with racist or insensitive descriptions of patients and their behavior.
It is interesting how health coverage has an influence on length of stay for gunshots. One could argue that the absence or presence of health coverage is a proxy for other types of behavior. For instance, are insured and uninsured gunshot patients similar or do they differ by an identifiable characteristic? Length of stay for Medicaid is especially long compared to being uninsured or even privately insured. At Tampa General Hospital uninsured length of stay is 4.9 days, 8 days for privately insured and two weeks (13.9 days) for those on Medicaid. All the Florida hospitals analyzed had length of stay for those insured by Medicaid that was longer than privately insured or uninsured. The analysis also found that insured patients are more likely to receive follow up care, such as rehab.
Various research studies have found that hospital length of stay varies by type of insurance coverage. A 2011 Annals of Family Medicine study looked at close to a million (849,866) hospital stays for adults age 18-64. The uninsured stayed approximately 2.77 days, whereas those with private insurance stayed 2.89. Patients with Medicaid coverage had the longest length of stay (3.19 days). Mortality was similar across all three types of insurance status.
It should come as no surprise that health insurance encourages longer hospital stays compared to those with no coverage. It is similarly easy to understand that traditional Medicaid, which has fewer gatekeepers such as prior authorization, may have longer stays than those who lack coverage. Hospitals have a financial incentive to keep paying customers longer than nonpaying customers. There is also the fact that people who get into gunfights are often gang members. Hospitals prefer to avoid any conflicts occurring in their facilities. A better analysis would compare length of stay for similar procedural codes. However, I suspect the results would be the same: insured patients stay longer than uninsured patients.
Read more at KFF Health News: Florida Hospitals Act Fast To Discharge Gun Victims — Especially if They’re Not Insured