Abstract 16601: Impact of Insurance Status on Emergent Versus Non-Emergent Hospital Encounters Among Adults With Congenital Heart Disease

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Background: Arguments against universal health insurance are ongoing, but insurance coverage may be beneficial in high-risk populations such as adults with congenital heart disease (ACHD). While the number of hospital visits have exponentially increased for ACHD over the last few decades, the impact of insurance on the type of hospital encounters remains unknown. Hypothesis: Uninsured ACHD patients are more likely to have emergent hospital encounters than those insured. Methods: Using California Office of Statewide Health Planning and Development Database from 01/2005 to 10/2015, we identified all hospital encounters that were emergent (which might or might not have resulted in an admission) or nonemergent among ACHD ≥18 years old. We determined the trends over time and odds of insurance status on emergent vs. nonemergent encounters. Results: Among 69,876,425 encounters, 72,142 were in patients with CHD diagnoses (mean age 49±12 years, 43% males, 52% Caucasian, 4% uninsured). 78% had severe CHD and 75% had a comorbidity. From 2005 to 2015, while all ACHD encounters increased by 108% (p for trend <0.0001), there was significantly higher increase in emergent than nonemergent encounters (331% vs. 87%; p<0.0001). The ratio of emergent:nonemergent encounters was significantly higher for uninsured than insured patients (3.18 vs. 1.02; p<0.0001). Non-cardiac diagnoses were more common among emergent than non-emergent encounters (68% vs. 36%; p<0.0001). Both before and after multivariable adjustment, uninsured status was associated with a significantly higher odds of emergent encounters for all ACHD (Figure), irrespective of CHD type, exhibiting the largest magnitude of effect compared to any other predictor. Conclusions: Efforts to enhance the ability to obtain and maintain insurance throughout the lifetime of ACHD patients might result in meaningful reductions in emergency encounters and a more efficient use of resources.