Why important?
The average hospital bill for an uninsured stay in 2007 was $19,400. When there is no insurance coverage, hospitals bill patients directly. The resulting burden of payment for uninsured individuals and their families can be substantial. Likewise, the costs of uncompensated care may represent a burden to hospitals and, ultimately, contribute to increases in health care costs to society overall.

Trends in health insurance coverage can be driven by several factors including changes in employer-sponsored health benefits, the incomes of working families, the costs of health insurance premiums, and the accessibility of public insurance programs. Lack of health insurance has serious consequences on an individual and societal level. The uninsured may be more likely to delay or forego necessary medical care until hospitalization is inevitable. In 2007, the total hospital bill for the uninsured exceeded $64.5 million in Hawaii.

Uninsured trends—increases in recent years
Between 1998 and 2007, the number of uninsured hospitalizations increased by 13 percent, which far exceeds the 7 percent overall increase in all hospital stays.  Of concern is the 60 percent spike in uninsured hospitalizations between 2005 and 2007 compared to a 0.1 percent increase among all hospitalizations. As the economy continues to struggle, the uninsured rate is expected to rise further.

The uninsured: an increase among young adults
In 2007, individuals ages 15 to 44 years comprised about 42 percent of the total Hawaii population, but accounted for nearly half of all uninsured stays.  While children and adolescents comprised a similar percentage of uninsured stays compared to their portion of all hospitals stays, this was not the case for 15-44 year olds. Nearly half of uninsured stays were among 15 to 44 year olds compared to about 30 percent of overall hospital stays. 

Admission source? No surprise: the Emergency Room
Relative to all hospital stays, uninsured stays are much more likely to begin in the emergency department (ED). Nearly 60 percent of uninsured stays originate in the ED compared to 38 percent of hospital stays overall.

Top reasons for hospitalization
The most common reason for an uninsured stay was newborn birth, accounting for more than 430 uninsured stays in 2007 (12 percent of uninsured stays).  Uninsured hospitalizations were more likely to be for skin infections, depression and alcohol and substance abuse when compared to the insured population. 

County differences: Maui County highest rate
Between 1998 and 2007, the proportion of uninsured hospitalizations grew on Maui County (by 63%) and Hawaii County (by 46%).  For all years, Maui County consistently had the highest uninsured hospitalization rate of all counties.

Uninsured stays decreased by 11 percent on C&C Honolulu and remained relatively stable on Kauai County.  The uninsured hospitalization rate for C&C Honolulu reached a low in 2005, but has steadily risen since 2005.   

Data views
• Data table: charges, discharges, average length of stay (ALOS)
• By year
• By age group
• By reason for hospitalization
• By county

Source of data
Hawaii – HHIC Online Reports, Inpatient Database

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