Insurance status affects children's ED care

Treatment of children in the emergency department (ED) varies according to medical insurance status, new findings indicate.

Using data for hospital ED and outpatient department visits from the National Hospital Ambulatory Medical Care Survey, researchers examined the relationship between insurance status and use of diagnostic tests or medical treatment during ED visits for children from 1999 to 2008. Children younger than 19 years were categorized as having private insurance, public insurance (ie, Medicaid or state health insurance), or no insurance.

Of nearly 85,000 ED visits over the 10-year period, 45% of children had private insurance, 43% had public insurance, and 12% had no insurance. Children with public or no insurance were almost 25% less likely to receive testing, medication, or undergo any procedure in the ED than children with private insurance.

It was not clear whether these differences reflect appropriate diagnostic workup, underuse of services in children without private insurance, or overuse in those with private insurance. Also, the effect of testing and intervention on outcomes could not be determined.

The researchers note that almost half of US children do not have private medical insurance and that ED use among the medically underserved is increasing, so the findings could have important implications. If further study indicates that children with public or no insurance have worse outcomes, greater scrutiny of hospital care for medically underserved patients would be warranted.

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