Inpatient hospital service utilization of the uninsured in Nebraska: Policy implications for addressing uncompensated care

Li Wu Chen, Michael D. Shambaugh-Miller, Jane L. Meza, Wanqing Zhang, Kelly L. Shaw, Keith J. Mueller

Research output: Contribution to journalArticlepeer-review


In order better to inform policymakers about financing uncompensated hospital care through appropriate allocation of resources among Nebraska communities, this study used seven years (1996-2002) of county-level data from multiple sources to examine the relationship between population economic factors and the hospital inpatient care use by uninsured patients. The generalized estimating equation (GEE) regression analysis showed that, at the county level, the population uninsurance rate and other economic factors (e.g., per capita income, the percentage of population receiving welfare) are statistically significant predictors of average hospital self-pay inpatient charge per resident. Residents in the three western regions of the state also incurred statistically higher per-resident hospital self-pay inpatient charges than did their counterparts in the three eastern regions. State policymakers in Nebraska can use our study results to allocate resources on the basis of community economic characteristics and geographic location, to help reduce the financial burden of caring for the uninsured to safety net hospitals. The study may have a wide application to other states examining the same policy issues. The model used in this study can be easily created for other states, as the required data are readily available.

Original languageEnglish (US)
Pages (from-to)444-457
Number of pages14
JournalJournal of health care for the poor and underserved
Issue number2
StatePublished - May 2009


  • Community economic development
  • Hospital care use by the uninsured
  • Medicaid disproportionate share hospital program
  • Rural
  • State health planning
  • Uncompensated hospital care
  • Uninsurance

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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