The Association Between Hospital Readmission and Insurance Provider Among Adults with Asthma

Context. Asthma is ranked as the ninth most common chronic condition in the U.S., and its annual direct costs from hospital services alone are estimated at $3.1 billion. Hospitalization rates due to asthma reveal several disparities and may be attributed to recent changes in the healthcare delivery system, including the penetration of managed care. Objective. To examine the relationship between 7-day hospital readmission and insurance provider among adults with asthma. Design. A retrospective cohort study that included patients aged 18-64 with a principal diagnosis of asthma, who were discharged from acute nonfederal hospitals in New Jersey between 1 January 1993 and 31 December 1996. In the absence of unique patient identifiers, a linkage system was used to match subsequent readmissions for the same patient to the first admission. Main Outcome Measure. Seven-day readmission. Results. Results showed a significantly increased risk of 7-day readmission for managed care patients as compared to indemnity patients (OR = 1.67, 1.10-2.53). Shorter lengths of stay were associated with greater odds of readmission (LOS = 0: OR = 5.17, 2.49-10.75, LOS = 1: OR = 2.30, 1.30-4.07). Conclusions. Managed care patients have shorter lengths of stay as compared to indemnity patients, which leads to an increased risk of returning to the hospital within a short period of time. In trying to provide cost-effective patient care, we may be discharging patients prematurely.