Association between Insurance Type and Extended Length of Stay in Urban & Rural Vermont Hospitals

Abstract

PurposeTo evaluate the link between insurance status and patient length of stay (LOS) for inpatient admissions in rural and urban hospitals in Vermont.MethodsWe conducted a cross-sectional study utilizing 2016 to 2020 data from the Vermont Uniform Hospital at Data Discharge System (VUHDDS). Vermont residents 18-64 years of age admitted for heart and circulatory illnesses who spent least one day as inpatient at one of Vermont’s 14 hospitals were included. Frequency statistics were run to determine distribution of sample characteristics and a two-side Z-test was conducted to compare differences between normal and extended lengths of stay. Three multivariate logistic regression models were utilized to control for confounding factors and identify differences in lengths of stay and mortality.FindingsPrivate insurance was more common among patients with a normal LOS (46%) and public insurance more common among patients with extended lengths of stay (54%). Rural Medicare patients have 0.77 (CI: 0.66-0.90) times lower odds of extended LOS, which is distinct from the 95% confidence interval for urban patients (CI: 0.94-1.46). Urban Medicaid insured patients had 1.413 (CI: 1.15-1.74) times greater odds of an extended LOS, which is outside of the 95% confidence interval for rural patients (CI: 0.80-1.09).ConclusionsIn conclusion, the rurality of a patient’s residence appears to impact health outcomes for cardiac related discharges for individuals in Vermont related to their insurer. Further studies with more demographic data are needed to better understand the implications of these findings.