Hospital Utilization by the Uninsured and Other Vulnerable Populations in New Jersey
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1 Hospital Utilization by the Uninsured and Other Vulnerable Populations in New Jersey Presented to The New Jersey Department of Health and Senior Services on June 16, 2004 by Derek DeLia, Ph.D. Assistant Professor/Senior Policy Analyst 0
2 Acknowledgements Rutgers Center for State Health Policy Elizabeth Wood Carl Schneider Joel Cantor New Jersey Department of Health & Senior Services Vincent Yarmlak Reginald Selden 1
3 Outline 1. Uninsured in NJ 2. Use of hospital-based charity care 3. Preventable hospitalizations 4. Summary/conclusion 2
4 Uninsured non-elderly adults and children in NJ 854, ,722 Non-Elderly Adults (19-64) Children (18 & Under) Source: NJ Family Health Survey,
5 Uninsured children in NJ by household income as a percentage of the Federal Poverty Level (FPL), % FPL 41% FPL 25% 201+ FPL Source: NJ Family Charity Health Care Claims Survey, Data
6 Uninsured non-elderly adults in NJ by household income as a percentage of the Federal Poverty Level (FPL), % 15% FPL FPL 32% 40% FPL 350+ FPL Source: NJ Family Charity Health Care Claims Survey, Data
7 Hospital-Based Charity Care NJ Hospital Care Payment Assistance Program Income-based subsidies 100% if income<200 FPL Sliding scale from FPL Emphasis on services delivered to patients 6
8 Charity Care Claims Data Payment date Calendar year Priced at Medicaid rates Does not reflect payment received Inflation adjusted CPI Base year
9 Total value of charity care claims in NJ * $631,713,232 $440,175,268 $464,178,787 $490,967, * Priced at Medicaid rates. Inflation adjusted using 2000 CPI. 8
10 Total Value of Charity Care Claims: Inpatient vs. Outpatient * Inpatient Outpatient Millions $400 $350 $300 $250 $200 $150 $100 $50 $ * Priced at Medicaid rates. Inflation adjusted using 2000 CPI. 9
11 Total charity care encounters by income as a percentage of the Federal Poverty Level in NJ, % 1% FPL FPL 97% FPL 10
12 Total charity care encounters in NJ by age of recipient, % 6% Age 0-17 Age % Age
13 Charity Care Encounters for Children and Elderly Patients, ,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 Age 0-17 Age
14 Cumulative Percentage Change in Charity Care Encounters by Age, Children (0-17) Adults (18-64) Elderly (65+) 103% 38% 10% 13
15 Percentage of inpatient charity care admissions in NJ by the Top 5 Major Diagnostic Categories (MDC s), 2002 MDC-20: Alcohol/Drug Disorders 17% MDC-5: Circulatory System 15% MDC-19: Mental Diseases 12% MDC-6: Digestive System 9% MDC-14: Pregnancy & Childbirth 8% 14
16 Percentage of inpatient charity care dollars in NJ by the Top 5 Major Diagnostic Categories (MDC s), 2002 MDC-5: Circulatory System 20% MDC-19: Mental Diseases & Disorders 13% MDC-20: Alcohol/Drug Disorders 11% MDC-6: Digestive System 9% MDC-7: Hepatobiliary/Genitourinary 6% 15
17 Preventable Hospitalizations Ambulatory care sensitive (ACS) admissions Age/sex adjusted rates per 1,000 individuals UB-92 & U.S. Census data Overall, Non-Hispanic (NH) Black, NH White Hispanic patients difficult to identify in UB Children & non-elderly adults 16
18 Preventable hospitalization rates per 1,000 children Total NH Black NH White Source: NJ Hospital Uniform Billing (UB-92) Data 17
19 Preventable hospitalization rates per 1,000 non-elderly adults Total NH Black NH White Source: NJ Hospital Uniform Billing (UB-92) Data 18
20 Charity Care Admissions for ACS Conditions 9,998 10,146 10,542 11,
21 Cumulative Percentage Change in Charity Care Admissions, Total ACS 18% 12% 20
22 Summary of findings - 1 Large and growing amount of resources are devoted to hospital-based charity care (CC) Primary users of CC are Non-elderly adults Individuals with income < 200 FPL Most common diagnoses among inpatient CC users Circulatory disorders Mental health Drug/alcohol disorders 21
23 Summary of findings - 2 Faster growing parts of CC system are Outpatient care Services to uninsured elderly Services to uninsured children CC for preventable hospitalizations growing slightly faster than CC overall Disparities in preventable hospitalizations between blacks & whites have recently narrowed 22
24 Appendix: Data on NJ s Uninsured NJ Family Health Survey Representative sample of individuals in NJ 6,466 individuals in 2,265 families Response rate 59.3% Weighted to represent population of NJ 23
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