Private Health Insurance Case Study

In the United States (U.S.), Private Health Insurance is the primary source of healthcare system for most people. For elderly citizens and eligible children and families from low-income households, public programs are the main source of health cover. Public programs consist of Medicare, Medicaid, State Children Health Insurance Programs (SCHIP). In 2010, the Patient Protection and Affordable Care Act (ACA) carries out a mandate that every American must have health insurance, or pay a fine [1]. ACA, also known as ObamaCare, aims to reduce healthcare costs, and provide affordable healthcare for everyone. Accordingly, the health insurance coverage increases from 84% to 88.5% [2]. The ACA health insurance marketplaces, namely health insurance

HCUP is a voluntary data collection of multistate, administrative, population-based data, developed through a Federal-State-Industry partnership [5] that contains encounter-level, clinical and nonclinical information including all-listed diagnoses and procedures, discharge status, patient demographics, and charges for all patients, regardless of payer (e.g., Medicare, Medicaid, private insurance, uninsured) in a uniform format with privacy protections in place [6, 7]. It provides access to healthcare databases for research and policy analysis, as well as tools and products to enhance the capabilities of the data [8]. HCUP databases contain the national databases including the National Inpatient Sample (NIS), the Kids' Inpatient Database (KID), and the Nationwide Emergency Department Sample (NEDS). These contain information on outpatient care, inpatient stays, and emergency department visits that enable research on a broad range of health policy issues including cost and quality of health services, patterns of medical practice, access to healthcare programs, and outcomes of treatments at the national, State, and local market levels [9, 10]. The HCUP databases and supplemental files are available

The NIS includes charge information for all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. It is intended to inform decision making in regard to health and healthcare at the national and regional levels. Through NIS data, researchers and policy makers can estimate national trends in healthcare utilization, access, charges, quality, and outcomes. With the sampling frame covering more than 95% of the U.S. population, the NIS is the largest all-payer inpatient care database which has been made publicly available in the U.S. since the 1988 data year. Moreover, beginning in 2012, the NIS was redesigned from the “sample of hospitals” to the “sample of discharges” which are from all hospitals participating in HCUP. It contains about 300 million discharges data from races of white, black, Hispanic, Asian/Pacific Islander, Native American, and other with age of 0 to 124 years [12]. NIS data types include primary and secondary diagnoses and procedures with ICD–9–CM code, patient demographic characteristics (e.g., sex, age, race, and median household income for ZIP Code), hospital characteristics (e.g., ownership), expected payment source, total charges, discharge status, length of stay, severity and comorbidity measures