AHRQ Stats: Medicaid Versus Private Insurance

From 2003 to 2012, Medicaid rather than private insurance increasingly became the leading payer of potentially preventable pediatric hospital stays for asthma and diabetes. By 2012, Medicaid paid 58 percent of the asthma stays compared with 36 percent paid by private insurance. That same year, Medicaid paid 47 percent of the diabetes stays while private insurance paid 45 percent of them. (Source: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project Statistical Brief #192: Potentially Preventable Pediatric Hospital Inpatient Stays for Asthma and Diabetes, 2003-2012.)

Potentially Preventable Pediatric Hospital Inpatient Stays for Asthma and Diabetes, 2003-2012

Kathryn Fingar, Ph.D., M.P.H. and Raynard Washington, Ph.D.

Highlights

In 2012, the rate of potentially preventable pediatric inpatient stays was 142.9 for asthma and 32.4 for diabetes per 100,000 children aged 0-17 years.

Between 2003 and 2008, the rate of potentially preventable pediatric stays decreased by 34 percent for asthma and 16 percent for diabetes but then increased 21 percent from 2008 to 2012 for both conditions.

By 2012, aggregate hospital costs totaled $417.2 million for asthma and $89.4 million for diabetes. This represents over a 50 percent increase from 2008, which is attributable to increases in the number of stays and average cost per stay.

Between 2003 and 2012, the rate of potentially preventable stays for asthma per 100,000 children aged 0-17 years decreased for all age groups, with a nearly 50 percent decrease for children aged 15-17 years (from 72.8 to 38.7). The rate in 2012 was over 7 times lower than the rate for children aged 0-4 years (290.4).

Rates of potentially preventable pediatric stays per 100,000 were more than twice as high in the lowest income quartile as in the highest for diabetes (43.0 vs. 18.9) and asthma (214.1 vs. 89.5) in 2012, although asthma stays declined the most among children from the poorest areas.

Medicaid was the leading payer of potentially preventable pediatric stays for asthma (58.1 percent) and for diabetes (47.2 percent) in 2012, reflecting a 10-year decline in privately insured hospital stays.