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
Acknowledgements Rutgers Center for State Health Policy Elizabeth Wood Carl Schneider Joel Cantor New Jersey Department of Health & Senior Services Vincent Yarmlak Reginald Selden www.cshp.rutgers.edu 1
Outline 1. Uninsured in NJ 2. Use of hospital-based charity care 3. Preventable hospitalizations 4. Summary/conclusion www.cshp.rutgers.edu 2
Uninsured non-elderly adults and children in NJ 854,877 237,722 Non-Elderly Adults (19-64) Children (18 & Under) Source: NJ Family Health Survey, 2001 www.cshp.rutgers.edu 3
Uninsured children in NJ by household income as a percentage of the Federal Poverty Level (FPL), 2001 34% 0-100 FPL 41% 101-200 FPL 25% 201+ FPL Source: NJ Family Charity Health Care Claims Survey, Data 2001 www.cshp.rutgers.edu 4
Uninsured non-elderly adults in NJ by household income as a percentage of the Federal Poverty Level (FPL), 2001 13% 15% 0-100 FPL 101-200 FPL 32% 40% 201-349 FPL 350+ FPL Source: NJ Family Charity Health Care Claims Survey, Data 2001 www.cshp.rutgers.edu 5
Hospital-Based Charity Care NJ Hospital Care Payment Assistance Program Income-based subsidies 100% if income<200 FPL Sliding scale from 200-300 FPL Emphasis on services delivered to patients www.cshp.rutgers.edu 6
Charity Care Claims Data Payment date Calendar year Priced at Medicaid rates Does not reflect payment received Inflation adjusted CPI Base year 2000 www.cshp.rutgers.edu 7
Total value of charity care claims in NJ * $631,713,232 $440,175,268 $464,178,787 $490,967,519 1999 2000 2001 2002 * Priced at Medicaid rates. Inflation adjusted using 2000 CPI. www.cshp.rutgers.edu 8
Total Value of Charity Care Claims: Inpatient vs. Outpatient * Inpatient Outpatient Millions $400 $350 $300 $250 $200 $150 $100 $50 $0 1999 2000 2001 2002 * Priced at Medicaid rates. Inflation adjusted using 2000 CPI. www.cshp.rutgers.edu 9
Total charity care encounters by income as a percentage of the Federal Poverty Level in NJ, 2002 2% 1% 0-200 FPL 201-274 FPL 97% 275-300 FPL www.cshp.rutgers.edu 10
Total charity care encounters in NJ by age of recipient, 2002 6% 6% Age 0-17 Age 18-64 88% Age 65+ www.cshp.rutgers.edu 11
Charity Care Encounters for Children and Elderly Patients, 1999-2002 50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 Age 0-17 Age 65+ 1999 2000 2001 2002 www.cshp.rutgers.edu 12
Cumulative Percentage Change in Charity Care Encounters by Age, 1999-2002 Children (0-17) Adults (18-64) Elderly (65+) 103% 38% 10% www.cshp.rutgers.edu 13
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% www.cshp.rutgers.edu 14
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% www.cshp.rutgers.edu 15
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 www.cshp.rutgers.edu 16
Preventable hospitalization rates per 1,000 children Total NH Black NH White 20 15 10 5 0 1998 1999 2000 2001 2002 Source: NJ Hospital Uniform Billing (UB-92) Data www.cshp.rutgers.edu 17
Preventable hospitalization rates per 1,000 non-elderly adults Total NH Black NH White 30 25 20 15 10 5 0 1998 1999 2000 2001 2002 Source: NJ Hospital Uniform Billing (UB-92) Data www.cshp.rutgers.edu 18
Charity Care Admissions for ACS Conditions 9,998 10,146 10,542 11,760 1999 2000 2001 2002 www.cshp.rutgers.edu 19
Cumulative Percentage Change in Charity Care Admissions, 1999-2002 Total ACS 18% 12% www.cshp.rutgers.edu 20
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 www.cshp.rutgers.edu 21
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 www.cshp.rutgers.edu 22
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 www.cshp.rutgers.edu 23