Burn Patient Insurance Status Influences Hospital Discharge Disposition and Utilization of Postdischarge Outpatient Care.

Abstract

Postdischarge services, such as outpatient wound care, may affect long-term health outcomes and postrecovery quality-of-life. Access to these services may vary according to insurance status and ability to cover out-of-pocket expenses. Our objective was to compare discharge location between burn patients who were uninsured, publicly insured, and privately insured at the time of their burn unit admissions. A retrospective review from July 1, 2015 to November 1, 2019 was performed at an American Burn Association-verified burn center. All admitted burn patients 18 years and older were identified and categorized according to insurance payer type. The primary outcome was discharge location, and secondary outcomes included readmission and outpatient burn care attendance. In total, 284 uninsured, 565 publicly insured, and 293 privately insured patients were identified. There were no significant differences in TBSA (P = .3), inhalation injury (P = .3), intensive care unit days (P = .09), or need for skin grafting (P = .1) between the three groups. For primary outcome, uninsured patients were more likely to be discharged without ancillary services (P < .0001) compared to both publicly and privately insured. Publicly insured patients were more likely to receive skilled nursing care (P = .0007). Privately insured patients were more likely to receive homecare (P = .0005) or transfer for ongoing inpatient care (P < .0001). There was no difference in burn unit readmission rates (P = .5). The uninsured were more likely to follow up with outpatient burn clinic after discharge (P = .004). Uninsured patients were less likely to receive postdischarge resources. Uninsured patients received fewer postdischarge wound care resources which could result in suboptimal long-term results, and diminished return to preinjury functional status. Given the impact of insurance status on discharge location and resources, efforts to increase access for uninsured patients to postdischarge resources will ensure greater healthcare equity and improve quality of comprehensive care regardless of insurance status.