Year of Publication



Martin School of Public Policy and Administration

Executive Summary

Health care costs in the United States are a concern to policy makers, healthcare providers, and the population using medical services. Because fewer individuals have health insurance, as costs continue to rise, so have the levels of charity care provided through the Emergency Departments at many hospitals. Hispanics are a growing population thought to be receiving an increasing portion of this care. The Hispanic population in Kentucky has seen a significant increase in recent years, in large part because of the demand for agricultural workers. It has been established that a sizeable part of the Hispanic migrant worker community is not in the country legally. Very little data is available for assessing the amount and cost of care provided to this specific group in most states, including Kentucky.

This study seeks to add to that knowledge base by determining the total and proportionate costs of medical care provided to uninsured Hispanics in the Central Kentucky region. Emergency department admissions data for Clark Regional Medical Center was collected for 2004. Information pertaining to insurance status, race, diagnosis, charges, payments, contractual adjustments and gender was obtained and analyzed with descriptive statistics and regression analysis to determine the factors most associated with nonpayment and the extent of nonpayment of charges for treatment in the emergency department.

A probit regression to determine the characteristics associated with incomplete payment of charges. Hispanic ethnicity, having private or no insurance, and having a primary diagnosis of a mental disorder were statistically significant. A linear regression to determine the characteristics associated with the amount of the bill unpaid demonstrated no significance of any ethnic group, but multiple diagnostic code groups, having no insurance, and having private insurance were associated with an increase in the amount of the bill that remained unpaid. Being female decreased the amount of the bill unpaid.

This study provides some description of the Hispanic population seeking medical care through the emergency department in Clark County, including common diagnoses. This information may be used to improve outreach to the uninsured Hispanic population. The analysis does not justify the initiation of new procedures to participate in new Federal funding programs to reimburse hospitals for care provided to undocumented immigrants in emergency departments.