P3A003: Public or Private: Does Insurance Type Really Matter in Hospital Readmission Rates for Adolescents with Eating Disorders

Background: Eating disorders (ED) are serious medical disorders with a high rate of relapse even after weight restoration and medical stability is achieved. There have been publications that suggest patients with public health insurance are less likely to receive authorization for the recommended level of care at discharge. This may lead to higher rates of readmission than those with private insurance.

In our study we wanted to examine the association between type of insurance (public vs private) and rate of readmission within 1 year of discharge for patients with ED admitted for malnutrition. We also examined possible confounding factors including primary language of parents, age, BMI, lowest heart rate, phosphorus and potassium, and percentage of oral intake as supplement prior to discharge.

Methods: We conducted a retrospective chart review of patients admitted to our pediatric eating disorder medical stabilization database from 2017 to 2020. We included patients between the ages of 11 to 25 years old that had a diagnosis of Anorexia Nervosa, Bulimia Nervosa or Eating Disorder Not Otherwise Specified and were admitted for malnutrition causing medical instability. We excluded patients that did not have an encounter in the system that was at least 1-year post-discharge and patients that had avoidant resistant food intake disorder, superior mesenteric artery syndrome, severe organic GI abnormalities, and autism. A linear regression model was used to analyze the clinical characteristics between the groups.

Results: We identified 107 patients that met the inclusion criteria and 36 of these patients had readmissions to our program. There was a significant difference in readmission rates between patients that had public versus private insurance: 57% (12 /21) of patients with public insurance were re-admitted compared to 28 % (24/86) of those with private insurance (p value < 0.02). None of the other potential confounders reached clinical statistical significance between those patients readmitted versus those not readmitted.

Conclusion: Insurance type was strongly associated with readmission of patients with ED in our medical stabilization program. We hypothesis that this is likely due to lack of ED-specific treatment facilities and programs that accept public insurance at discharge. Consequently, these patients are more likely to relapse without the appropriate step-down level of care. Making appropriate treatment options more easily accessible to patients with public insurance may potentially be more cost effective by avoiding costly hospital readmissions.