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More health insurance doesn't mean more time in the ICU

By Maryalene LaPonsie on January 6th, 2014

If anyone is wondering whether the Patient Protection and Affordable Care Act will lead to skyrocketing use of the ICU, researchers from the University of Pennsylvania say the answer is probably not.

The researchers led a study to consider how Massachusetts universal health insurance mandate affected usage of the intensive care units in that state. According to their findings, there is no correlation between health insurance coverage and admissions to ICUs.

Health insurance coverage may prevent need for ICU care

When Massachusetts required all adults to obtain health insurance coverage in 2007, the number of critically ill individuals who were uninsured dropped from 9.3 percent to 5.1 percent. Despite having access to insurance to pay for medical care, these individuals did not appear to head to the ICU in droves, as some had feared.

In fact, the Penn researchers hypothesize medical insurance may actually serve to reduce the number of patients admitted to the ICU each year.

"Greater access to care allows for better preventive care, which may reduce ICU admissions and ultimately an individual's risk of death in the ICU," said Dr. Sarah M. Lyon, the study's lead author, in a written statement. "Individuals with insurance may also be more likely to come to us earlier in the course of their illness when their acute illness severity is lower."

Comparing critical care costs and outcomes

The study reports the cost of caring for critically ill patients accounts for 17 to 38 percent of hospital costs. In addition, those numbers could be expected to increase as the nation's population ages.

Researchers not only considered ICU trends in Massachusetts, they also compared the state's data to that of four other states: New York, Washington, Nebraska and North Carolina. These states were chosen because they are not only closely aligned to the demographics found in Massachusetts but also believed to be representative of the nation as a whole.

Although Massachusetts residents had greater levels of health insurance coverage, there were no significant changes in ICU admissions, discharge destinations or ICU mortality found between the states.

The takeaway may be that although health insurance reform doesn't seem to increase ICU usage, it doesn't diminish it either. However, researchers note a different study looking at Medicaid-expansion didn't find noticeable differences in mortality until five years after the expansion took place. They note their Massachusetts data ended 29 months after the state began requiring mandatory health insurance coverage and a look at more recent data may paint a different picture.

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