Self Pay Study: Trends in Hospital Utilization by Uninsured Southern Californians

Brief Description
Appropriate reimbursement for services hospitals provide is critical to their solvency. Due to recent hospital closures in Southern California and increasing number of the uninsured, hospitals are growing anxious about their financial well being. This study updates ongoing reports on trends in hospital utilization by uninsured persons in Los Angeles, Riverside, and San Bernardino Counties. The report utilizes data from the 2000 through 2007 Office of Statewide Health Planning and Development (OSHPD) Patient Discharge and Emergency Department databases as well as 2008 and 2009 hospital surveys to conduct the analyses.

ED vists and patients who were admitted through the ED were identified by payment source: self pay/county indigent program (SP/CIP), Medi-Cal, Medicare, private insurance and other sources. Hospitals studied were grouped by disproportionate share status (DSH), and whether they were county owned or private. Descriptive statistics are used to compare changes in uninsured use of ED and inpatient services within and between hospital groups over time.

The update is currently underway with a findings report expected by August 31, 2009. Results from NHF’s previous Self Pay studies indicated that private hospitals are experiencing significant increases in caring for the uninsured in many regions of Southern California. Further, the proportion of admissions via the ED represented by payers with inadequate sources (i.e., Medi-Cal, self pay, and county indigent programs) is also increasing at a number of private hospitals. As such, overall reimbursement for private hospital services in many Southland regions continues to deteriorate threatening their financial viability. Finally, private hospitals, regardless of DSH status, are bearing an increasing majority of the risk of serving the underinsured in some Southern California Counties.

Policy Implications
As the economy weakens and unemployment rises, numbers of underinsured will increase placing further stress on an already distressed hospital system. Without adequate reimbursement for hospital services, additional emergency department and hospital closures should be expected.

Hospital Association of Southern California

Andrew Barnes, Phone: 213-538-0707, Email: