When inequity impacts clinical care: an analysis of length of stay and reimbursement rates for medical stabilization for anorexia nervosa based on insurance coverage.

BACKGROUND: The recent COVID-19 pandemic has had a significant effect on the rates and severity of anorexia nervosa (AN) leading to rises in admissions for medical stabilization. To improve care and effectively allocate limited resources, we need a better understanding of the factors that lead to prolonged hospitalization in patients with AN. METHODS: We performed a retrospective chart review of 139 adolescent and young adult patients admitted a combined 196 times for medical instability due to AN at a large pediatric hospital in the Midwest region of the United States. We used multiple linear and Poisson regression modeling to look for differences in length of hospital stay and reimbursement rates based on payor type (public vs. private), while controlling for demographic and clinical factors which may impact length of stay. We then looked at hospital charges and reimbursement rates by payor type, using two-sided t-tests. RESULTS: Multiple regression models demonstrated that patients with public insurance tended to have a longer length of stay, despite similar degrees of medical instability. Reimbursement rates were significantly and substantially less from public insurance companies compared to private. CONCLUSIONS: To our knowledge, this is the first study examining length of stay and reimbursement rates for medical stabilization based on insurance status. Understanding the effects of a tiered insurance scheme on both clinical and fiscal outcomes will be key to improving care provided to patients with AN.