Opportunities for Increasing Value of Health Services Among Frequently Hospitalized Indigent Patients in a Public Hospital

Abstract

Public hospitals that experience high rates of uncompensated care need to identify new ways in which to manage their highest cost patients, those who are medically indigent and have frequent and recurrent hospital admissions. This study reports on patterns for a sample of uninsured patients, compared to insured patients at a public hospital in Denver, Colorado. The profile of uninsured individuals and the patterns of care associated with their hospital admissions appear to be different than expected from reports of other hospital readmission studies. Uninsured readmission patients are more often younger than expected, male, homeless, substance abuse patients, chronically mentally ill, and lost to follow-up care. These factors are comorbid conditions associated with chronic medical illnesses and suggest the need for a unique approach to fully integrated case management efforts across the continuum of care and in the context of the larger community for specialized resource management.