Impact of payer status on utilization of ambulatory and hospital services

The United States not only spends more per capita on health care than any other country but also has one of the fastest growth rates in health spending among developed countries. Despite this higher level of spending, one of the major problems with the U.S. health care system is access to care for individuals who lack health insurance. Prior studies (e.g. Canto et al. 2000; Hadley 2003) have suggested that payer status may be an important determinant of medical resource utilization and outcome. This study examines the impact of insurance type on healthcare utilization; a nationally representative sample of approximately 55,000 individuals from the 2007 National Health Interview Survey (NHIS) was compared within 8 payer groups to ascertain the influence of payer status on ambulatory and hospital resource utilization in the United States. Our empirical analysis is based on OLS, Probit, and Tobit regression models of the impact of payer status on several utilization outcomes while controlling for health status and socioeconomic factors. Our study demonstrates that the insured population has a greater number of overnight hospitalizations annually and pays more visits to health care professionals than uninsured individuals. Our analysis by payer type indicates that only individuals with Medicare coverage and Private Health Insurance are more likely to have visited a health care professional at a doctor\u27s office than the uninsured, even after controlling for sociodemographic characteristics and health status; those with Medicare coverage exhibited the highest number of such visits. Individuals with Medicaid coverage were the most likely to have been hospitalized overnight in comparison to the uninsured and also exhibited the highest number of overnight hospitalizations in the past year. These findings are consistent with previous literature (Arndt et al. 1998), which reports that Medicaid patients experience delays in care, resulting in longer hospital stays. Finally, we analyzed the impact of payer status on utilization across cohorts of patients with chronic illnesses and found that health care utilization disparities do in fact vary by specific health conditions