Impact of Insurance and Hospital Ownership on Hospital Length of Stay Among Patients With Ambulatory Care–Sensitive Conditions

PURPOSE Some studies suggest proprietary (for-profi t) hospitals are maximizing fi nancial margins from patient care by limiting therapies or decreasing length of stay for uninsured patients. This study examines the role of insurance related to length of stay once the patient is in the hospital and risk for mortality, particu- larly in a for-profi t environment. METHODS We undertook an analysis of hospitalizations in the National Hospital Discharge Survey (NHDS) of the 5-year period of 2003 to 2007 for patients aged 18 to 64 years (unweighted n = 849,866; weighted n = 90 million). The analysis included those who were hospitalized with both ambulatory care-sensitive condi- tions (ACSCs), hospitalizations considered to be preventable, and non-ACSCs. We analyzed the transformed mean length of stay between individuals who had Med- icaid or all other insurance types while hospitalized and those who were hospital- ized without insurance. This analysis was stratifi ed by hospital ownership. We also examined the relationship between in-hospital mortality and insurance status.