1. Estimates of Hawai`i’s Uninsured from Hospital Emergency Department & Inpatient Data—the Latest Update
The Hawaii Coverage for All Project
Technical Workshop VIII
January 30, 2006
Susan Forbes, DrPH
Jill Miyamura, PhD
Hawaii Health Information Corporation

2. Why does ED and hospital data matter?
Extensive literature on the inferior health status of the uninsured
Extensive literature on the negative impact that lack of insurance has on the stability of the health system
Evidence that the uninsured use the ED for primary care
Provides yet another view of the issues involved

3. Data Sources
Data submitted monthly by hospitals to Hawaii Health Information Corporation
All emergency departments except Tripler, Kahuku and Molokai
All acute care hospitals (inpatient data)

4. Uninsured ED Visits

5. Uninsured ED Visits by Sex

6. Uninsured ED Visits by Sex and Age, 2004

7. Uninsured ED Visits by Island

8. Top 10 Reasons for ED Visit by Insured Status, 2002
Infectious Disease and Dental were not one of the top ten reasons for ER visits in 2002 for the insured. Similarly, General medicine is much higher for the uninsured than the insured. This suggests that the uninsured may be using EDs for primary care.

9. Top 10 Reasons for ED Visit by Insured Status, 2004
Dermatology, General medicine, Psychiatry, Infectious Disease higher for the uninsured than the insured.

10. Inpatient Admissions from ED by Status
When admitted to the Inpatient, people that may not have had insurance are found to see if they qualify for insurance under QUEST. One of the reasons the IP records show a very low uninsured rate.

11. Top 10 Reasons for Admission from ER by Insured Status
Once people are admitted into the inpatient setting, the reasons for being admitted become similar, further suggesting that the uninsured may use EDs for primary care.
2004

12. Preventable Hospitalization by Insurance Status
For 0-64 only. Does not include low birth weight.

13. Preventable Hospitalizations by Payer
For 0-64 only. Does not include low birth weight.

14. Preventable Hospitalizations Charges by Payer
For 0-64 only. Does not include low birth weight.

15. Preventable Hospitalizations ALOS by Payer
For 0-64 only. Does not include low birth weight.

16. Preventable Hospitalizations by County
For 0-64 only. Does not include low birth weight.

17. Preventable Hospitalizations by County and Insured Status
For 0-64 only. Does not include low birth weight.

18. ED Charge per Visit by Insured Status

19. ED Charge per Visit by Payer
Uninsured burden to hospitals—In 2002, the charges to the uninsured were over $50 million for inpatient and ED combined.

20. Burden to the Hospitals
In 2004, charges to the uninsured were over $64 million for ED and inpatient combined

21. Top Reasons for ED Infectious Disease
Diagnosis
Insured
Uninsured
Cellulitis
68%
81%
Viral Illness
23%
13%
Over80 percent of uninsured visits are for cellulitis, an ambulatory care sensitive condition.

22. Top Reasons for ED Psychiatry
Diagnosis
Insured
Uninsured
Alcohol or Drug Abuse
28%
46%
Acute Anxiety
24%
17%
Over seventy percent of uninsured visits are for cellulitis, an ambulatory care sensitive condition.

23. Top Reasons for ED General Medicine
Diagnosis
Insured
Uninsured
Sign & Symptoms Influencing Health Status
42%
51%
Toxic Effects of Non-Medicinal Substances
14%
12%
Over seventy percent of uninsured visits are for cellulitis, an ambulatory care sensitive condition.

24. Questions?
Susan Forbes
MAHALO!!!