Among Moser's findings:

* The uninsured received an average of 1.49 procedures per hospitalization, compared with 1.68 for insured
* For uninsured inpatients, the principal radiologic procedure had 7.8 RVUs on average, compared with 8.8 for the insured, a statistically significant difference (p<.01)

* Uninsured radiology inpatients received 12 percent fewer RVUs, compared with insured inpatients
* Uninsured persons whose principal radiological modality was nuclear medicine received 15 percent fewer total procedures compared with insured persons (p<.10)

Moser says it is important to remember that the study looked at persons who were admitted to the hospital and received at least one radiologic service. "That leaves unanswered the question of how large the radiologic service deficit is for uninsured persons who should have been admitted to the hospital, but were not for some reason," he says.

Care providers may not be aware of patients' insurance status

Though Moser's study is not yet peer-reviewed, he offers several possible explanations for his findings.

One strong possibility is that physicians in the hospital setting are not aware of the patient's insurance status. "Likely, the radiologist doesn't know," Moser says, "and perhaps even the referring physician treating the patient may not know. That would explain why we didn't find more differences than we did."

On the other hand, Moser says, hospitals may have implicit practices to restrict services for patients who are unable or not required to pay, such as among uninsured patients admitted through emergency departments. However, Moser notes this is "pure speculation."

Moser offers another possibility: Instead of the uninsured receiving too few costly imaging procedures, the insured may be receiving too many. "If you realize that the insured patient is only paying a fraction of the true cost of the service, you might say, 'Let's go ahead and do whatever is deemed medically beneficial because the patient is not going to have to pay the majority of the bill,'" he suggests. Similarly, he says physicians making medical decisions may try to limit the cost to known self-paying patients, realizing that such patients would have to pay out-of-pocket.

Moser is working on a similar analysis of ambulatory patients. "It's not as far along," he says. "It will be interesting to compare whether the setting - inpatient hospital, outpatient hospital, or doctor's office - matters."

Moser says that if he and his co-author had found that the uninsured were in poorer health because they were not getting enough radiology services, they might have called for policy changes. "But data limitations prevented us from studying that," he says.

More Industry Headlines