Effect Of Health Insurance Status Research Articles

Access to healthcare services and factors associated with unmet needs among migrants in Phuket Province, Thailand, 2023: a cross-sectional mixed-method study

BackgroundPhuket Province is a major tourist destination with a migrant workforce accounting for 10% of its population. Despite governmental efforts to adjust health insurance policies, migrants face healthcare access challenges. This study examines the current healthcare access situation and factors associated with unmet needs among migrants in Phuket Province.MethodsWe used a cross-sectional mixed-methods approach, recruiting participants through snowball sampling from the Migrant Health Volunteer Network. Quantitative data were gathered using self-administered questionnaires, with unmet need defined as desired outpatient or recommended inpatient services not received at government hospitals. Multivariable logistic regression identified unmet need predictors, and we assessed the mediating effect of health insurance status. Qualitative data from three focus groups on healthcare access provided context and enriched the quantitative findings.ResultsThis study includes 296 migrants mainly from Myanmar. The overall unmet need prevalence was 14.86%, mainly attributed to having undocumented status (34.09%), affordability issues (20.45%), and language barriers (18.18%). Working in the fishery industry significantly increased unmet needs risk (aOR 2.68, 95% CI 1.08–6.62). Undocumented status contributed a marginal total effect of 4.86 (95% CI 1.62–14.54), with a natural indirect effect through uninsured status of only 1.16 (95% CI 0.88–1.52). Focus group participants used various medical resources, with insured individuals preferring hospital care, but faced obstacles due to undocumented status and language barriers.ConclusionValid legal documents, including work permits and visas, are crucial for healthcare access. Attention to fishery industry practices is needed. We recommend stakeholder discussions to streamline the process of obtaining and maintaining these documents for migrant workers. These improvements could enhance health insurance acquisition and ultimately improve healthcare affordability for this population. These insights could be applied to migrant workers in other urban and suburban area of Thailand regarding access to government healthcare facilities.

Estimating the Role of Uninsured in the Spread of COVID-19 via Geospatial Bayesian Models

In this article, we develop and use several geospatial models to estimate the effects of health insurance status and vaccination coverage in the spread of COVID-19. We focus on COVID-19 related mortality, infection, and fatality rates as health outcomes. Utilizing these existing methods an analysis is conducted at the national level using data for every county in the United States, then a case is formed with analyses where the counties are restricted to those within Texas and Mid USA, which includes Nebraska, Iowa, Missouri, and Kansas. The main goal of this study is to investigate how different factors, such as vaccination status, socioeconomic status including insurance, and geographic location, may have affected the geospatial spread of COVID-19 pandemic and related health outcomes. Results show that the percentage of the senior population, the vaccination rate and the uninsured percentage are the most important variables for predicting infection rates and the fatality rates, while the overall social vulnerability index has a huge impact on mortality rates and infection rates. Our analyses can shed light on the impact of health insurance status and inform policy makers regarding the importance of health insurance coverage.

The Effects of Health Insurance Coverage on Workforce Engagement of Family Caregivers of Children With Intellectual Disability and Autism.

For many families of children with intellectual disability and autism (ID/ASD), private health insurance and public programs, such as Medicaid and the Children's Health Insurance Program (CHIP), are critical sources of support. The purpose of this study was to examine the impact of health insurance coverage on workforce engagement of parents of children with ID/ASD. The study utilized 2014-2018 pooled National Health Interview Survey data to construct national estimates and test the effects of health insurance status on parent workforce outcomes. Primary findings indicate significantly higher odds of workforce absence (OR = 2.83, p < .0038) and unemployment (OR = 8.91, p < .0038) among parents with children with ID/ASD using public health insurance, compared to the reference group. Additionally, parents of children with ID/ASD who were uninsured were found to experience significantly higher unemployment (OR = 4.86, p < .0038) than the reference group. Findings have policy and research implications related to workforce engagement for parents, including issues impacting health insurance coverage, specifically related to Medicaid and CHIP.

Effect of Health Insurance Status and Visitation Restrictions on Virtual Visitation Technology in the Neonatal Intensive Care Unit.

This study aimed to examine the relationship between virtual technology system utilization and insurance status or type of visitation restrictions in a single-center neonatal intensive care unit. Prospective cohort study with separate analyses performed based on insurance status (public vs. nonpublic) and "in effect" unit visitation restrictions. The three study epochs based on patient visitation restrictions were Epoch 1 (July to October 2019) with standard visitation restrictions, Epoch 2 (November 2019 to February 2020) with respiratory syncytial virus/influenza visitation restrictions, and Epoch 3 (March to June 2020) with coronavirus disease 2019 (COVID-19) visitation restrictions, respectively. Families of 357 infants used web-based cameras through most of the infant's hospitalization (median: 86.05%, Q3: 97.9%) with 165,795 total camera logins, indicating consistent utilization. There was a trend for fewer logins per infant and significantly longer time to consent (p = 0.03) in the Public Insurance group. Unit visitation restrictions impacted the time to consent, the shortest being in Epoch 3 during the COVID-19 pandemic (p = 0.03). Virtual visitation technology is well embraced by neonatal instensive care unit families; however, gaps in access and use among subgroups signals a form of social inequality that needs to be explored further. · Virtual visitation technology can bridge the distance gap for families of hospitalized infants.. · Utilization of virtual technology is affected by socioeconomic factors and seasonal unit visitation restrictions.. · Factors influencing disparities in access and utilization of virtual technology need to be investigated further..

The Effect of Health Insurance Status on School Attendance.

Introduction Educational achievement is impacted by a student's ability to be present and motivated in the classroom. Since health and education influence one another, disparities in health insurance status amongchildren may exert educationally relevant consequences. However, the association between health insurance coverage and school absenteeism remains poorly understood. Our study aims to assess the association between not having/having gaps in health insurance coverage and an increased number of missed school days. Methods A historical cohort study was performed via secondary analysis of data collected as part of the 2018 National Survey of Children's Health (NSCH). We included children enrolled in school between the ages of 6-17 yearsand who provided answers to survey questions involving our two variables of interest: health insurance status and missed school days. Our data analysis included 1) a descriptive analysis of the baseline sample characteristics, 2) a bivariate analysis to determine the association between baseline characteristics/confounding variables and the outcome, and 3) a multivariable regression analysis using logistic regression to determine the association of interest while controlling for potential confounding variables. Results A total of 21,498 respondents were included. The unadjusted odds of chronic absenteeism were found to be 16% (OR=1.16) higher in children without insurance or with gaps in insurance compared to children with consistent insurance throughout the year, but the association was not statistically significant (95% CI 0.74 - 1.82, p=0.051). After adjustment by age, sex, race, Hispanic ethnicity,and confounding variables, the odds of chronic absenteeism in children without insurance or with gaps in insurance remained statistically insignificant (aOR=1.05; 95% CI 0.64 - 1.73, p=0.848) compared to those with consistent insurance coverage. Conclusions According to our analysis, the data do not support our hypothesis of a significant difference in missed school days (greater than or equal to 11 missed days of school) among those children who had health insurance compared to those without health insurance/had gaps in insurance coverage.

The effect of health insurance status on treatment intensity in heart attack patients: an IV approach

ABSTRACT The purpose of this exercise is to determine if patients suffering from heart attacks receive different levels of treatment intensity based on insurance status, accounting for possible endogeneity between insurance status and treatment intensity. This possible endogeneity is addressed through an instrumental variables approach and results suggest that insurance status is not as impactful on treatment intensity once endogeneity is accounted for.

The Effect of Health Insurance on Racial Disparities in Patients with Isolated Colorectal Liver Metastases

Introduction: Resection of colorectal liver metastases (CRLM) is associated with improved overall survival compared to palliative chemotherapy. Prior literature has demonstrated that Black patients are less likely to undergo surgical treatment compared to other races. However, little is known about the impact of health insurance on racial disparities. Aim of this study was to evaluate the effect of health insurance status on racial disparities in receipt of surgical therapy in patients with CRLM. Method: A retrospective cohort study of patients diagnosed with stage IV colorectal cancer with isolated CRLM was performed using the National Cancer Database (NCDB) (2006-2016). Primary outcome was receipt of surgical therapy for CRLM. Multivariable logistic regression (MVR) was performed to evaluate the association of race and health insurance with surgical resection. Results: A total of 6,002 patients were included: 70.5% White, 16.7% Black, 6.6% Hispanic, and 6.2% Other race. Rates of resection, systemic chemotherapy, and multimodality therapy were lower among Black compared to White patients. By MVR, Black patients had lower odds of liver resection compared to White patients. Uninsured patients were also less likely to undergo resection compared to patients with private insurance. On MVR of race stratified by health insurance, only Black patients with Medicare had decreased odds of undergoing liver resection compared to White patients. [Table] Conclusions: Black patients with CRLM have lower odds of liver resection compared to White patients, particularly among the Medicare-insured population. Further investigation is warranted to better understand racial disparities and develop implementation strategies to address them.Tabled 1Race (ref=White)Insurance StatusReceipt of ResectionOdds RatioReceipt of Resection95% Confidence IntervalBlackPrivate/Managed Care0.960.73-1.27Uninsured1.620.66-3.97Medicare0.550.38-0.78Medicaid0.840.52-1.38HispanicPrivate/Managed Care1.000.67-1.50Uninsured1.960.78-4.91Medicare0.700.39-1.25Medicaid0.910.49-1.71 Open table in a new tab

Health insurance status and outcomes in children, adolescents, and young adults: a systematic review and meta-analysis.

The impacts of health insurance status on survival outcomes in children, adolescents, and young adults (aged 0-39 years) with malignant tumors have not been addressed in depth. The present study aimed to identify significant relationships of health insurance condition with overall survival or all-cause mortality among children (age 0-14 years) and adolescents and young adults (AYAs, age 15-39 years) with malignant tumors. PubMed, Wiley Cochrane Central Register of Controlled Trials, Econlit, CINAHL, Web of Knowledge, PsychInfo, Business Source Premier, ProQuest Dissertation & Theses Database, and SCOPUS were systematically searched from inception to February 29, 2020 with no language restriction. All related articles comparing the effect of health insurance status on the risk of overall survival and the risk of all-cause mortality in malignant conditions affecting children and AYAs were identified. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were computed using a random- or fixed-effect model as per the heterogeneity evaluated using Cochran`s Q and I < sup > 2 < /sup > statistics. Fourteen studies including 149,680 individuals were selected for this meta-analysis. The pooled RR for all-cause mortality with insurance versus without insurance was 0.78 (95%CI, 0.71-0.86; I2=33.7%). Among the insurance types, patients with private insurance presented with a lower all-cause mortality (RR 0.70, 95% CI 0.60-0.82), with considerable heterogeneity (I2=83.3%). The findings of this review suggest that a lack of or insufficient insurance is related to all-cause mortality of AYAs with malignant cancers. Strategies aimed at identifying causality and reducing disparities are warranted.

The effect of health insurance on racial disparities in patients with isolated colorectal liver metastases

Presenter: Anastasios Mitsakos MD | East Carolina University Background: Resection of colorectal liver metastases (CRLM) is associated with improved overall survival compared to palliative chemotherapy in patients with stage IV colorectal cancer. Prior literature has demonstrated that Black patients are less likely to undergo surgical treatment for metastatic disease compared to patients of other races. However, little is known about the impact of health insurance on racial disparities. The primary aim of this study was to evaluate the potential effect of health insurance status on racial disparities in receipt of surgical therapy in patients with CRLM. Methods: A retrospective cohort study of patients diagnosed with stage IV colorectal cancer with CRLM in the absence of extrahepatic metastatic disease was performed using the National Cancer Database (NCDB) (2006-2016). The primary outcome of interest was receipt of surgical therapy for hepatic metastatic disease. Multivariable logistic regression (MVR) was performed to evaluate the association of race and health insurance status with the odds of surgical resection. A two-way interaction term was incorporated in the MVR to evaluate the potential heterogeneity of race effect across insurance status. Results: A total of 6,002 patients were included: 70.5% White, 16.7% Black, 6.6% Hispanic, and 6.2% Other race. Rates of resection were lower among Black compared to White patients (17.7% vs. 22.0%), as were rates of systemic chemotherapy (72.0% vs. 75.1%) and multimodality therapy (40.1% vs. 44.9%). By MVR, Black patients had lower odds of undergoing resection for CRLM compared to White patients (OR 0.81, 95% CI 0.67-0.99). No difference was observed among patients of Hispanic or Other races compared to White patients. Uninsured patients were also less likely to undergo resection compared to patients with private health insurance (OR 0.53, 95% CI 0.36-0.76). No statistically significant difference in the odds of resection was observed among other health insurance categories. On MVR of race stratified by health insurance status, only Black patients with Medicare insurance had decreased odds of undergoing surgical therapy for CRLM compared to their White counterparts (OR 0.55, 95% CI 0.38-0.78). No difference in odds of resection was observed among patients of any other race or health insurance category. [Table] Conclusion: Black patients with CRLM have lower odds of receipt of resection for CRLM compared to White patients, particularly among the Medicare-insured population. Further investigation is warranted to better understand racial disparities in the Medicare population and develop implementation strategies to address them.

Effects of insurance status on long-term survival among non-small cell lung cancer (NSCLC) patients in Beijing, China: A population-based study.

ObjectiveTo evaluate the effects of health insurance status on long-term cancer-specific survival of non-small cell lung cancer (NSCLC) in Beijing, China, using a population-based cancer registry data.MethodsInformation on NSCLC patients diagnosed in 2008 was derived from the Beijing Cancer Registry. The medical records of 1,134 cases were sampled and re-surveyed to obtain information on potential risk factors. Poorly-insured status was defined as Uninsured and New Rural Cooperative Medical Insurance Scheme (NRCMS), while well-insured included Urban Employees Basic Medical Insurance (UEBMI) and Free Medical Care (FMC). To estimate survival outcomes, individuals were followed-up until December 31, 2018. Cancer-specific survival probabilities at 5 and 10 years after diagnosis were estimated using the Kaplan-Meier method. Log-rank test was used to compare long-term survival with different characteristics. Multivariable Cox proportional hazard regression model was used to examine the relative effect of insurance status on cancer-specific mortality.ResultsWell-insured NSCLC patients have longer cancer-specific survival than poorly-insured individuals [hazard ratio (HR)=0.81; 95% confidence interval (95% CI): 0.67−0.97), even after adjusting for age, gender, cancer stage, smoking status, family history and residential area. Older age and rural residence were associated with a higher risk of cancer-specific mortality (HR=1.03; 95% CI: 1.02−1.03 and HR=1.25; 95% CI: 1.07−1.46, respectively). Smoking individuals had a 41% higher long-term cancer-specific mortality risk than non-smoking ones (HR=1.41; 95% CI: 1.20−1.66).ConclusionsNSCLC patients with good insurance status had better survival rates than those with poor insurance. An association was significant even after 10 years. Large population-based studies are needed to validate that high reimbursement insurance status can lead to the improvement of long-term cancer prognosis in China.

Is There A Non-Essential Hospitalization Day In Inpatients With Diabetes Under Medical Insurance? Evidence From An Observational Study In China.

PurposeNon-essential hospitalization day of inpatient diabetes threatens health seriously and contributes to great economic burden on individuals and the society. Studying the essential utilization of hospitalization services is conducive to the reduction in the burden of diabetes. The purpose of this study is to identify the existence of non-essential hospitalization days during hospitalization in diabetic patients through exploring the use of health care in different types of insured patients.Patients and methodsA sample of 6731 admission records from 5929 hospitalized patients was studied. Binary logistic regression was performed to estimate the adjusted effects of health insurance status on readmission. Multiple stepwise linear regression was performed to estimate the adjusted effects of health insurance status on length of stay (LOS), direct medical expenses (DME), out-of-pocket (OOP) expenditures, and percentage of individual payment after reimbursement (PIPAR). Adjusted odds ratios (with 95% CI) were reported as the results of logistic regression models and linear regression models, respectively.ResultsAdjusted 7-day readmission rate and 30-day readmission rate were not significantly different between urban and rural resident basic medical insurance (URRBMI) and urban employee basic medical insurance (UEBMI). Compared with inpatients under URRBMI, the adjusted LOS and DME were significantly higher for UEBMI inpatients (adjusted OR of 2.6, 95% CI=1.9–3.2, adjusted OR of 1870.85, 95% CI=1370.97–2370.73, respectively). Adjusted OOP and PIPAR were significantly lower for UEBMI inpatients (adjusted OR of－970.86, 95% CI =−1111.63–−830.10, adjusted OR of −0.19, 95% CI=−0.20–−0.18, respectively).ConclusionThere was a non-essential hospitalization day existing in the treatment of diabetes. Moral hazard has been found in UEBMI which would trigger overtreatment in hospitalization of diabetics, and the lower PIPAR of UEBMI was one of the main causes of moral hazard.

Differences in Perceived Waiting Time by Health Insurance Type in the Inpatient Sector: An Analysis of Patients With Breast Cancer in Germany.

Although the relationship between health insurance and waiting time has been established in the ambulatory sector in Germany, research in the inpatient sector is limited. This study aims to contribute to previous work through analyzing differences in perceived waiting time by health insurance type during the inpatient stays of patients with breast cancer in Germany. This study utilizes cross-sectional data from 2017 of patients with breast cancer (N = 4626) who underwent primary breast cancer surgery in a certified breast care center in Germany. Results from multilevel logistic regression models indicate a significant effect of health insurance status on perceived waiting time, net of other relevant factors (patient’s sociodemographic background, Union for International Cancer Control stage, grading, self-reported and classified health, type of surgery, and chemotherapy). Patients with statutory insurance were significantly more likely than privately insured patients to report long waiting times for examinations/procedures, discharge, and to speak with the physician. There were no significant differences in waiting time for nursing staff between private and statutory insurance holders. Results align with previous findings in the ambulatory sector and suggest a private health insurance advantage, with private patients receiving priority to some health care services. Disparities in health care accessibility and quality need to continue to be addressed and discussed, as well as the impact of health insurance type on other indicators of health.

Effects of Health Insurance Among Patients on Hepatitis C Treatment Along the Texas-Mexico Border

Introduction: The incidence of hepatitis C virus (HCV) infection is increasing along the U.S.-Mexico border and across the world. There are significant implications for patients who are non-funded and seeking treatment for hepatitis C that are faced by border communities. Having a disproportionate number of individuals without insurance and high rates of undocumented residents may influence treatment outcomes for HCV patients. The purpose of this project was to examine the effect of health insurance status and office visit compliance on sustained virologic response (SVR) in adult patients living along the Texas-Mexico border treated for HCV. Methods: We conducted a longitudinal retrospective chart review of patients who underwent treatment with dual and triple therapy in a border community in Texas. The sample included patients between the ages of 18 and 65, with a diagnosis of HCV, who underwent HCV treatment between January 01, 2010 and August 15, 2013, El Paso, Texas. Data were collected from the charts of patients who received HCV treatment with pegylated interferon, ribavirin, and a protease inhibitor. Results: A total of 76 charts were reviewed. Twenty patients met study criteria and were included in the data analysis. The other 56 (73%) patients did not complete treatment or did not return for SVR testing. Of the 20 patients who were included in the study, 19 (95%), were Hispanic, 12 (50%) were female, age included 11 (55%), age 20-29, 7 (35%), age 30-39, 2 (10%) age 40-49. Most patients were overweight with BMI 18-25 in 3 (15%), BMI 25-30 in 9 (45%), and BMI >30 in 8 (40%). Eleven patients were genotype 1, 4 were genotype 2, 5 were genotype 3. Of the 20 patients included in the study, 4 had insurance and 16 did not. Of the 16 patients who were non-funded, all 16 patients were on an indigent managed health care program. SVR was achieved in three-fourths (75%) of patients with insurance versus 12/16 (75%) without insurance (p=1.0). Gender, age, and HCV PCR baseline level did not show significant effects on SVR response using multiple logistic regression analysis. Conclusion: In conclusion, in this sample of HCV patients treated in a Texas-Mexico border community, insurance status did not affect SVR outcomes. Patients who did not have insurance, but were provided some type of assistance or managed care program, completed treatment and had high SVR rates. Disclosure - Roberta Romero DNP, RN, FNP-C has received honoraria from Genentech, Vertex, and Gilead Pharmaceuticals and is on the speaker’s bureau for Genentech and Gilead. Ogechika Alozie has received honoraria from Abbvie Pharmaceuticals and is on the speaker’s bureau for Abbvie and ViiV.

The effect of health insurance status on the treatment and outcomes of patients with colorectal cancer.

Uninsured and underinsured cancer patients often have delayed diagnosis and inferior outcomes. As healthcare reform proceeds in the US, this disparity may gain increasing importance. Our objective was to investigate the impact of health insurance status on the presentation, treatment, and survival among colorectal cancer (CRC) patients. A total of 10,692 patients diagnosed with CRC between 2004 and 2008 identified from the Tennessee Cancer Registry were stratified into five groups: Private, Medicare, Military, Medicaid, and uninsured. Multivariable regression models were constructed to test the association of insurance with receipt of recommended adjuvant therapy and overall survival (OS). Uninsured and Medicaid patients were more often African American (AA) and presented with higher stage tumors (P < 0.001). Medicare patients were less likely to receive recommended adjuvant therapy (OR 0.54). Lack of insurance, Medicaid, and failure to receive recommended adjuvant therapy were independently associated with worse OS. Although uninsured and Medicaid patients receive recommended adjuvant therapy comparable to other patients, they present with later stage disease and have a worse OS. Future studies are needed to better explain these disparities especially in the light of changing healthcare climate in the US.

Patient satisfaction with primary health care - a comparison between the insured and non-insured under the National Health Insurance Policy in Ghana.

Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics, health insurance and the various dimensions of quality of care.This study employs logistic regression using household survey data in three districts in Ghana covering the 3 ecological zones (coastal, forest and savannah). It identifies the service quality factors that are important to patients’ satisfaction and examines their links to their health insurance status.The results indicate that a higher proportion of insured patients are satisfied with the overall quality of care compared to the uninsured. The key predictors of overall satisfaction are waiting time, friendliness of staff and satisfaction of the consultation process. These results highlight the importance of interpersonal care in health care facilities. Feedback from patients’ perception of health services and satisfaction surveys improve the quality of care provided and therefore effort must be made to include these findings in future health policies.

School Superintendents' Perceptions of Schools Assisting Students in Obtaining Public Health Insurance

Superintendents' perceptions regarding the effect of health insurance status on academics, the role schools should play in the process of obtaining health insurance, and the benefits/barriers to assisting students in enrolling in health insurance were surveyed. Superintendents' basic knowledge of health insurance, the link between health and learning, and specific school system practices for assisting students were also examined. A 4-page questionnaire was sent to a national random sample of public school superintendents using a 4-wave postal mailing. Only 19% of school districts assessed the health insurance status of students. School districts' assistance in helping enroll students in health insurance was assessed using Stages of Change theory; 36% of superintendents' school districts were in the action or maintenance stages. The schools most often made health insurance materials available to parents (53%). The perceived benefits identified by more than 80% of superintendents were to keep students healthier, reduce the number of students with untreated health problems, reduce school absenteeism, and improvement of students' attention/concentration during school. The 2 most common perceived barriers identified by at least 50% of superintendents were not having enough staff or financial resources. Most superintendents believed schools should play a role in helping students obtain health insurance, but the specific role was unclear. Three fourths of superintendents indicated overwhelmingly positive beliefs regarding the effects of health insurance status on students' health and academic outcomes. School personnel and public policy makers can use the results to support collaboration in getting students enrolled in health insurance.

Health Insurance Status Affects Staging and Influences Treatment Strategies in Patients with Hepatocellular Carcinoma

Lack of health insurance is associated with poorer outcomes for patients with cancers amenable to early detection. The effect of insurance status on hepatocellular carcinoma (HCC) presentation stage and treatment outcomes has not been examined. We examined the effect of health insurance status on stage of presentation, treatment strategies, and survival in patients with HCC. The Tennessee Cancer Registry was queried for patients treated for HCC between January 2004 and December 2006. Patients were stratified by insurance status: (1) private insurance; (2) government insurance (non-Medicaid); (3) Medicaid; (4) uninsured. Logistic, Kaplan-Meier, and Cox models tested the effects of demographic and clinical covariates on the likelihood of having surgical or chemotherapeutic treatments and survival. We identified 680 patients (208 private, 356 government, 75 Medicaid, 41 uninsured). Uninsured patients were more likely to be men, African American, and reside in an urban area (all P < 0.05). The uninsured were more likely to present with stage IV disease (P = 0.005). After adjusting for demographics and tumor stage, Medicaid and uninsured patients were less likely to receive surgical treatment (both P < 0.01) but were just as likely to be treated with chemotherapy (P ≥ 0.243). Survival was significantly better in privately insured patients and in those treated with surgery or chemotherapy (all P < 0.01). Demographic adjusted risk of death was doubled in the uninsured (P = 0.005). Uninsured patients with HCC are more likely to present with late-stage disease. Although insurance status did not affect chemotherapy utilization, Medicaid and uninsured patients were less likely to receive surgical treatment.

S099 The Effect of Health Insurance Status on Stage at Diagnosis for Laryngeal Cancer

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Children's health insurance status and emergency department utilization in the United States.

Emergency department (ED) overcrowding has become a national problem. Children account for nearly 25% of overall ED visits. It has been reported that uninsured and publicly insured children are likely to visit the ED for urgent and nonurgent problems, yet it remains unclear to what extent health insurance status would influence children's overall ED utilization or ED utilization for nonurgent problems at the national level after controlling for other confounding factors. The objective of this study was to examine the effect of health insurance status on children's overall ED utilization and children's ED utilization for nonurgent problems among the general pediatric population in the United States. Secondary analysis of the household component of the 1997 Medical Expenditure Panel Survey on 10 193 children younger than 18 years. The main outcome measures were annual overall ED utilization and ED utilization for nonurgent problems. During 1997, 10.8% of children were uninsured for the entire year. A total of 17.5% of children were publicly insured the entire year, whereas 55.3% of children held private insurance the entire year. There were also 16.5% of children who were insured only part of the year. Without adjusting for covariates, publicly insured children were more likely to have an ED visit during the year than both privately insured children (unadjusted odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.03-1.55) and uninsured children (unadjusted OR: 1.46; 95% CI: 1.1-1.95). The difference between publicly insured and privately insured children (adjusted OR: 0.90; 95% CI: 0.70-1.16) and between publicly insured and uninsured children (adjusted OR: 1.12; 95% CI: 0.84-1.49) became insignificant after controlling for covariates. With or without adjustments for covariates, there was no significant difference in the likelihood of having an ED visit between privately insured and uninsured children. Similar to the utilization pattern of overall ED visits, publicly insured children were more likely to have a nonurgent ED visit than both privately insured (unadjusted OR: 1.86; 95% CI: 1.36-2.53) and uninsured children (unadjusted OR: 1.81; 95% CI: 1.15-2.84). Both differences disappeared after controlling for covariates. There was no significant difference in the likelihood of nonurgent ED visits between privately insured and uninsured children with or without adjustments for covariates. Health insurance status was not associated with children's overall ED use or children's ED use for nonurgent problems at the national level. Our findings suggest that policy efforts in an attempt to relieve ED overcrowding conditions should look for measures beyond solely making changes in health insurance coverage for children.