Short Takes On News & Events

Study: Privately Insured Kids Get More Care In ED

By Jenny Gold

May 10th, 2012, 6:39 AM

Emergency departments are required to treat everyone who comes through the doors, but that doesn’t mean they treat everyone the same way.

Insurance coverage may play a major role in the kind of care a young patient receives, according to a study published in the most recent edition of The Journal of Pediatrics.

Children with public insurance (Medicaid or CHIP) or who had no coverage are at least 22 percent less likely than those with private insurance to receive testing or to undergo procedures when they visit the hospital emergency departments, researchers from Children’s Hospital Boston found.  In addition, children with no insurance are less likely to receive any medication than children with public or private insurance.

That disparity did not hold true for kids diagnosed with a significant illness, who had the same odds of being admitted to the hospital regardless of insurance status.

The study is based on an analysis of emergency department visits recorded in the National Hospital Ambulatory Medical Care Survey from 1999-2008.  The survey collects data on approximately 33,000 visits annually.

It’s not clear whether the results indicate that ERs are skimping on care for uninsured and publicly insured kids, or perhaps overtreating kids with private insurance coverage, which tends to pay hospitals more. In a press release, lead study author Dr. Rebekah Mannix notes that “because ED physicians are salaried or paid by the hour, it is uncertain how or why a child’s insurance status could be associated with care decisions in the ED.”

The study authors posit several other possible explanations.

Children with private insurance are 11 times more likely than uninsured children, and three times more likely than those with public insurance, to have a primary care doctor, according to the Agency for Healthcare Research and Quality.  That means privately insured kids are more likely to have been referred to the ER by their doctor, with instructions for a specific workup, including extra tests and procedures.  And they’re less likely to seek out non-emergency care in the ER.

It’s also possible that patients and parents with fewer resources also request less testing and treatment because of financial concerns, the authors suggest.

Almost half of all children do not have private insurance, according to government data.

7 Responses to “Study: Privately Insured Kids Get More Care In ED”

  1. This study fails to mention that majority of emergency room/department visits by uninsured are similar to what their insured counterparts have treated in a doctors office- cold, allergies, and therefore unlikely to require advanced treatment or prescriptions. In fact, the study states that for serious ailments there was no difference in the quality, or amount, of care administered to insured children or uninsured children.

    As for those insured publicly as opposed to privately, those patients are often advised to visit an ER as opposed to doctor’s office, to prevent excessive costs, one to the doctor’s practice and another to the hospital. So they too are often treated for ailments that are not serious enough to require advanced treatment or prescriptions.

  2. Jason T says:

    The study also fails to mention that clinicians treating patients have no idea what their insurance status is. That is taken by the ED secretary/administrator upon arrival and not passed along to the clinical team. There is no scarlet letter worn by an uninsured or publicly insured patient. I’m saddened by my colleagues’ blatant attempt to politicize something that needs no further explanation.

  3. Howard F says:

    Agree with above comments. In pedi ED I don’t see the insurance status unless have to check, which is a pain, for which Rx. Patients without pcp, or a lousy one, are visiting for low acuity visits. Patients with private insurance either sicker, or the PCP has already decided that a big work up needs to be done. Now, often that work up isn’t needed, and I am stuck either doing it or risking the patient satisfaction hit for over riding what their Dr told them.

    Patients who are truly sick, will get the same care, as noted in study.

  4. CB says:

    This study is clearly limited in its conclusions and basis. It does not support or qualify any explanation for the reported disparity. In my experience, children with public insurance have less or more difficult access to primary care, their parents have financial and socioeconomic challenges, and their ED reason for visits tend to be of less acuity than their privately insured cohort. The reason for less diagnsotic and medication utilization is because they are “less sick” , don’t need the testing (and are willing to accept the my reasoning whereas the insured patients can be more challenging to persuade) may have already been to the ED for the same complaint, etc.

  5. Michele J says:

    The commnets to this point seem to indicate that the publicly/uninsured patients are likely getting what is medically necessary and those with private insurance are likely overtreated. Whether it is because privately insured patients have PCPs who are pre-ordering tests or parents who refuse to be satisfied until a battery of testing is done, the bottom line is that privately insured patients are likely receiving unnecessary testing. This of course contributes to increased premiums and puts access to private insurance out of reach for even more Americans.

  6. There is indeed a scarlet letter worn by the uninsured and under-insured. In a fee for service world, doctors, hospitals, etc are keenly aware of their own bottom lines. That’s the nature of a for-profit system. The scarlet letter is spoken, not worn. An insurance card is requested, it is photocopied, verified by a computer check. “I don’t have one” is the scarlet letter.

    As a former business owner of two businesses, I was incentivized to hire people part time to avoid paying health insurance premiums. And I did. Medical care givers practice in a for-profit model and their business minds function fully next to their medical ones.

    Medicine is rationed by for-profit insurance companies who answer to the god of quarterly dividend reports. And we are all oppressed by the ogres eating up 30% of every healthcare dollar on salaries, dividends, advertising, all things non-medical.

  7. Dr. LaJoie says:

    Mr. Business Man “Art As Social” Don’t equate your obvious greed and maleficence with my honorable intentions to care for the most patients in the most efficient manor. I have worked as a Pediatric ER doctor for 22 years in all types of settings and there is NO scarlet letter. You should keep your trap shut about things of which you obviously know nothing about. The comments my colleagues left are completely accurate. Medicaid recipients are huge consumers of ED care for many reasons: 1. EDs are open the hours they can come. 2. There are few primary care practices in their neighborhoods 3. Even if they have a primary care physician they often have to wait too long for an appointment and many schools will not allow the child back into school or daycare without a note from a doctor 4. And finally they often don’t trust the quality of the physician to which they have been assigned by Medicaid. The uninsured can go to any ED and must be seen and treated with the same standard of care as the insured, that is the law (see EMTALA). So yes, they come to the ED for minor medical complaints and therefore they don’t need tests. Conversely, well insured kids have already had a preliminary evaluation and tests as an outpatient and the primary care physician has determined they need more urgent evaluation or possible admission to the hospital. ER medicine is an honorable profession filled with hard working intelligent physicians and nurses who are the heroes and the safety net of our health care system and I’m not going to let an idiot like you to make any other conclusion.