Awareness of Patients’ Health Insurance Status: Underutilized Tool in Optimizing in Quality of Care

1Unity Health System, Rochester, NY

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 300

Case Presentation:

Case I—a 45‐year‐old man was admitted to the hospitalist service with fever and leg swelling. Physical examination was significant for tachycardia, hypotension, and gangrene of left leg. From blood cultures, complete blood count, and blood chemistry, he was found to have sepsis because of a diabetic foot infection and was treated with intravenous fluids and antibiotics. Discharge plan was for completion of a 14‐day course of linezolid. Two days later, he paged the discharging resident physician because his prescriptions could not be filled because his insurance needed prior authorization for linezolid. Four days later, he received the drug but was readmitted 1 week later because of relapse of the foot infection and spent 6 more days before eventual discharge. Case II—a 32‐year‐old morbidly obese female smoker reluctantly presented to the emergency room and was admitted because of cough, fever, and shortness of breath for the past 2 weeks. On examination she was pyrexic and tachycardic and had fine crackles at both lung bases. Laboratory studies showed marked leukocytosis with a left shift, lactic acidosis, and acute renal failure. She was offered admission for management of her severe community‐acquired pneumonia. She asked the physician, “Why can't you just give me a prescription so I can go home?” and said she was scared of admission because of the cost, as she lacked coverage, and went home. She was readmitted the next day with septic shock and spent 7 days in the intensive care unit.


The number of uninsured Americans was 50 million people in 2010. The increasing use of hospitalists has reduced the length of stay and health care costs by 17%–30% and 13%– 20%, respectively. However, hospitalists are under intense scrutiny for quality‐of‐care issues including inadequate handover and premature discharges. Improved knowledge of the health insurance status of patients can play a pivotal role in aiding hospitalists to facilitate discharge planning, order outpatient follow‐up tests, and link patients to appropriate services. Care facilitators, social workers, and nurses all know about patients’ social circumstances and insurance coverage status. The hospitalist who takes most management decisions needs to be more aware and responsive to patients’ social deficiencies in coverage, such as a lack of or incomplete coverage. The majority of these patients may have their first contact with the health care system at this point, and a significant proportion are uninsured. Patients between 20 and 35 years of age and the unemployed often lack or have inadequate health insurance.


Hospitalists’ awareness of the health insurance status of patients can have important management implications. Better knowledge of the patient's health insurance status by the hospital is an underexplored way of addressing these safety lapses.


O. J. Ilonze ‐ none; M. Matos ‐ none

To cite this abstract:

Ilonze O, Matos M. Awareness of Patients’ Health Insurance Status: Underutilized Tool in Optimizing in Quality of Care. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 300. Journal of Hospital Medicine. 2011; 6 (suppl 2). Accessed January 22, 2020.

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