More than 47 million Americans lack health insurance and more than half of them have been uninsured for a year or more, according to recent federal figures.But how are radiological services impacted by the growing number of uninsured?

Surprisingly, research by American College of Radiology economists shows that uninsured hospital patients receive nearly the same number of radiology services as insured hospital patients. However, the ACR study also found that uninsured hospital patients receive fewer higher-value radiology services than the insured.

"Because we know Americans without health insurance receive fewer health-care services than those with insurance, we might have thought that the uninsured also would get fewer radiology services," says James W. Moser, Ph.D., the ACR's senior director of economics and health policy, who led the study. "However, that was not what I found. I essentially found that there was no statistical difference between the two - insured and uninsured - when it comes to the number of imaging services performed."
Further analysis did show that a disparity exists among the types of radiology services the uninsured receive compared to the insured.

"When I looked at distribution of those services, I noticed that radiologic services provided to the uninsured tended to be the less expensive modalities such as X-rays," Moser says. "It was not a huge difference compared to the insured, but it was statistically significant."

Analysis includes seven modalities, 2003 hospital data

Moser's study looked at seven modalities: CT, MRI, X-ray, ultrasound, nuclear medicine, radiation oncology, and interventional radiology. He analyzed a year's worth of data from the National Hospital Discharge Survey (NHDS), from the National Center for Health Statistics. The NHDS annually collects medical, demographic, and payment information from discharge records selected from a national sample of non-federal, short-stay hospitals. Moser looked at NHDS data from 2003, the latest available.

He divided patients into two groups: uninsured, which included the self-pay and no-charge patients, and insured, which were all who had third-party payers.

For each modality, Moser used the relative value units (RVUs), which are used to determine Medicare reimbursement rates, to quantify the different values of the radiology services provided. Using economic and statistical analytical tools, Moser considered the following variables: insurance status, patient demographics, severity of illness, type and source of admission, length of stay, and hospital characteristics.

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