Hospital Utilization by Payer for Youths and Young Adults with Sickle Cell Disease in Michigan

Abstract

Background
Sickle cell disease (SCD) is a rare, genetic blood disorder associated with significant morbidity. Children with SCD have frequent interactions with the healthcare system, including acute care (i.e., emergency department (ED) visits; inpatient admissions). Most studies of acute care in this population have focused on children insured by Medicaid; therefore, little is known regarding other payers of acute care in this population.
Objective
Characterize ED visits, inpatient admissions, and inpatient length of stay by primary payer among youths and young adults living with SCD in Michigan.
Methods
The Michigan Sickle Cell Data Collection Program (MiSCDC) is a public health surveillance program funded by the CDC. MiSCDC aims to identify individuals living with SCD in the state of Michigan and collect their health information over time through linking multiple data sources, such as newborn screening, Medicaid, discharge data (Michigan Inpatient and Outpatient Database), vital records, and clinic reports. The study population consisted of individuals ages 0-29 living with SCD in Michigan in 2018. For individuals in the study population, all ED visits, inpatient admissions, and length of stay were identified using Medicaid and discharge data and further characterized by payer. Potential primary payer categories included Medicaid, Medicare, private insurance, self-pay and other (e.g., auto insurance, Title V).
Results
There were 1,929 people ages 0-29 living with SCD in Michigan in 2018 (31.8% ages 0-10, 28.8% ages 10-19, and 39.4% ages 20-29). These individuals had 4,961 total ED visits in 2018. 80.3% of ED visits had Medicaid as primary payer, 7.0% had Medicare, 10.6% had private insurance, 1.1% had self-pay, and 1% had other insurance. There were 2,285 inpatient admissions in 2018; 69.1% of the total visits had Medicaid as primary payer, 9.1% had Medicare, 18.2% had private insurance, 0.8% had self-pay, and 2.8% had other insurance. The average length of stay was 2.5 days for inpatient admissions with Medicaid as primary payer, 4.0 days for Medicare, 1.9 days for private insurance, 1.1 days for self-pay, and 1.4 days for other insurance types.
Conclusion
In youths and young adults, the majority of ED and inpatient visits were covered by Medicaid in the study population. However nearly 20% of ED visits and over 30% of inpatient admissions were covered by other payers, primarily private insurance. Length of stay was longest for admissions covered by Medicaid and Medicare. Further research exploring differences in disease severity and health outcomes by payer are necessary to assess opportunities for improvement in the quality of care for those living with SCD, particularly among adolescents and young adults.

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