Abstract
Introduction: Providing health insurance to the poor has become a standard policy response to health disparities between the poor and the non-poor. It is often assumed that if the poor people are given health insurance, they will use preventative care, which will prevent more expensive emergency visits and inpatient hospitalization, and in turn, it will save healthcare cost in the long run. This paper presents the findings from our study in California about what happens to the poor when they are given health insurance. The purpose of the study was to understand how the healthcare system in California treats the poor patients differently than the non-poor. Method: Using multivariate logistic regressions, this study analyzed a large patient discharge data (PDD) from the California Office of Statewide Planning and Development (OSHPD) for eight counties in the Central Valley California (N = 423,640). First, utilizing International Classification of Diseases (ICD 10) as diagnostic criteria, mental-health vs. non-mental health hospitalization rates were estimated. Second, health insurance status was used as a proxy measure of poverty of the patients. Using chi-Square, the probability of hospitalization for mental health services was estimated based on their insurance types. Finally, using step-wise logistic regression, the odds of mental health hospitalization was estimated conditional on individual characteristics, health insurance types, and geographic characteristics. Findings: When the poor people were given health insurance, they were three times more likely to be hospitalized for mental health services than the non-poor. The more than three-fold variation in mental health hospitalization was not driven by demographic or geographic characteristics. The findings are new and have important implications for the healthcare policies for the poor. Further studies are needed to understand the extent to which the disproportionately high rate of mental health hospitalizations of the poor are driven by the provider-induced needs.
Highlights
Providing health insurance to the poor has become a standard policy response to health disparities between the poor and the non-poor
When the poor people were given health insurance, they were three times more likely to be hospitalized for mental health services than the non-poor
While much has been written about the under-utilization of health services by the poor due to the lack of insurance, very little is known about what happens when the poor people are given health insurance. Do they utilize health services as predicted? Does it reduce inpatient hospitalization? Using health insurance type as a proxy measure of poverty status of the patients, this study examined the pattern of inpatient hospitalization for health services among the poor in Central Valley California
Summary
Providing health insurance to the poor has become a standard policy response to health disparities between the poor and the non-poor. The purpose of the study was to understand how the healthcare system in California treats the poor patients differently than the non-poor. The Central Valley California has the highest concentration of poverty in the U.S [1,2]. It has high disease rates and health disparities [3]. Poverty has serious effects on the health of the poor [4], and the poor people in Central Valley California suffer from a disproportionately high level of diseases burdens and low quality of life. The Central Valley California, presents itself as a perfect natural laboratory to study how poor people are being treated by the current healthcare system. For example, that the poor are less likely to receive mental health
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